Publications

Masks and respirators have played an essential role in the response to the COVID-19 pandemic for both healthcare workers and the public. However, the masks and respirators that both healthcare workers and the public have needed to rely upon leave much to be desired. Despite drawbacks in terms of comfort and fit, the ubiquitous disposable masks and disposable N95 respirators used by the vast majority of healthcare workers have not appreciably improved since the mid-1990s. During the COVID-19 pandemic, the public has been advised to wear masks as well. Masks have long been known to be effective means of “source control” (ie, reducing transmission of respiratory droplets from the wearer to others). More recently evidence has accumulated that properly constructed and worn masks as well as respirators afford a limited but not inconsequential degree of protection to the wearer as well. Existing masks and respirators run the gamut in terms of effectiveness and wearability. In a future large-scale outbreak or pandemic, it is possible to increase the protection of healthcare workers and the public from infection through more efficient, well-fitting, and comfortable masks. The design and manufacture of better masks and respirators are possible by harnessing emerging technologies, the innovative research and development spirit evidenced since the early days of the COVID-19 pandemic, and the availability of resources to support technological innovation.

Healthcare and hospital workers providing care and support to infected patients during a pandemic are at increased risk for mental distress. Factors impacting their mental health include high risk of exposure and infection, financial insecurity due to furloughs, separation from and worries about loved ones, a stressful work environment due to surge conditions with scarce supplies, traumatic experiences due to witnessing the deaths of patients and colleagues, and other acute stressors. Finding ways for institutions to support the mental wellbeing of healthcare and hospital workers in an acute pandemic-related crisis situation is of critical importance. The factors affecting mental health are deeply connected to work-related motivation and attendance. Willingness to come to work is multifactorial and is dependent upon an individual’s self-perception of risk, as well as having the skills and resources necessary to perform work tasks given the nature of the public health emergency. Social and material support for healthcare workers in a variety of high-stress and high-risk settings is important for supporting workers’ mental health and in maintaining their commitment in challenging conditions.

The so-called “gain of function” research has been recently debated in the context of viral research on coronaviruses and whether it is too risky to undertake such experiments. However, the meaning of “gain of function” or “GOF” in a science policy context has changed over time. The term was originally coined to describe two controversial research projects on H5N1 avian influenza virus and was later applied to specific experiments on coronavirus. Subsequent policies and discussions have attempted to define GOF in different ways, but no single definition has been widely accepted by the community. The fuzzy and imprecise nature of the term has led to misunderstandings and has hampered discussions on how to properly assess the benefit of such experiments and biosafety measures.

COVID-19 has fundamentally challenged the delivery of health care services across the world, forcing difficult choices on health professionals and laying bare many preexisting health, medical, and public health sector frailties. Extreme shortages of key resources and worries that patients would not receive the care they needed were frequent features of the response beginning in the spring of 2020 and were recurrent during subsequent regional and national peaks.

Field simulation exercises (FSXs) require substantial time, resources, and organizational experience to plan and implement and are less commonly undertaken than drills or tabletop exercises. Despite this, FSXs provide an opportunity to test the full scope of operational capacities, including coordination across sectors. From June 11 to 14, 2019, the East African Community Secretariat conducted a cross-border FSX at the Namanga One Stop Border Post between the Republic of Kenya and the United Republic of Tanzania. The World Health Organization Department of Health Security Preparedness was the technical lead responsible for developing and coordinating the exercise. The purpose of the FSX was to assess and further enhance multisectoral outbreak preparedness and response in the East Africa Region, using a One Health approach. Participants included staff from the transport, police and customs, public health, animal health, and food inspection sectors. This was the first FSX of this scale, magnitude, and complexity to be conducted in East Africa for the purpose of strengthening emergency preparedness capacities. The FSX provided an opportunity for individual learning and national capacity strengthening in emergency management and response coordination. In this article, we describe lessons learned and propose recommendations relevant to FSX design, management, and organization to inform future field exercises.

The COVID-19 pandemic has affected all aspects of “normal” life in the United States, demonstrating weaknesses in pandemic preparedness and response. While several novel initiatives have been implemented since the start of the COVID-19 pandemic, not all available resources have been deployed to their maximum potential—biosafety professionals are one such resource that could be better used to support local pandemic response.

National debate persists surrounding the expanded use of nurse practitioners in the emergency department. Current understanding of the alignment of nurse practitioner educational preparation and practice parameters in United States emergency departments is inchoate. The objective of this review was to seek evidence to support that nurse practitioner education and training align with current practices in the emergency department.

In this paper, we present a research agenda for longitudinal risk communication during a global pandemic. Starting from an understanding that traditional approaches to risk communication for epidemics, crises, and disasters have focused on short-duration events, we acknowledge the limitations of existing theories, frameworks, and models for both research and practice in a rapidly changing communication environment. We draw from scholarship in communication, sociology, anthropology, public health, emergency management, law, and technology to identify research questions that are fundamental to the communication challenges that have emerged under the threat of COVID-19. We pose a series of questions focused around 5 topics, then offer a catalog of prior research to serve as points of departure for future research efforts. This compiled agenda offers guidance to scholars engaging in practitioner-informed research and provides risk communicators with a set of substantial research questions to guide future knowledge needs.

Seven months into the COVID-19 vaccination campaign in the United States, nearly 50% of the American population has been vaccinated. While this is a monumental accomplishment, there is still much work to do.

In the coming months, the country will face a series of vaccination challenges including serving groups with persistently low vaccine uptake (due to, for example, low/no access, vaccine hesitancy, or a combination of factors), expanding COVID-19 vaccination to children (particularly those whose parents may be less willing to vaccinate their children than to get vaccinated themselves), and orchestrating a potential booster dose campaign (with its own hesitancy issues). As the COVID-19 vaccination campaign continues, lessons from the vaccine rollout to date can help provide direction moving forward.

On February 10 and 11, 2021, the Johns Hopkins Center for Health Security hosted a virtual meeting of the Southeast Asia Strategic Multilateral Biosecurity Dialogue. Due to health risks stemming from the COVID-19 pandemic as well as associated restrictions and protective measures implemented around the world, the dialogue meeting originally scheduled to be held in Cebu, Philippines, during 2020 was postponed. To continue the productive dialogue between the participating countries, a virtual meeting was held to specifically address challenges and lessons from the countries’ experiences with COVID-19.

The trajectories of infectious disease and racial injustice in the United States have been inextricably entwined for centuries. Smallpox, for example, is thought to have arrived with Europeans to the Americas in the 16th century bringing devastating effects to Indigenous populations.¹ By the 17th century, numerous reports detail efforts by colonists to deliberately infect Native Americans, becoming one of the earliest documented histories of intentional biological warfare. Further links between infectious disease and racial injustice can be traced to the 1721 smallpox epidemic that ravaged Boston. During this time, the Puritan minister Cotton Mather advocated widely for inoculation, a procedure wherein dried pus from a smallpox patient was scraped into a healthy person's skin to build immunity.² Mather had learned of inoculation from an enslaved man named Onesimus, who brought knowledge of the practice from Africa. After Zabdiel Boylston, a local physician, successfully tested the procedure on his own son and 2 enslaved household members, he and Mather launched a public inoculation campaign. However, they encountered pushback from White Bostonians, some of whom questioned the validity of African medical practices and speculated that inoculation was a ploy to kill slaveowners. Another physician, William Douglas, went so far as to satirically advocate for using inoculation as a weapon against Native Americans, proposing cash rewards for each death.^2,3 Ultimately, though, only 1% to 2% of inoculation recipients died of smallpox during the outbreak, compared to 15% of Bostonians who were infected naturally.³

One of the lessons learned from the COVID-19 pandemic is the utility of an early, flexible and rapidly deployable disease screening and detection response. The largely uncontrolled spread of the pandemic in the United States exposed a range of planning and implementation shortcomings, which if they had been in place before the pandemic emerged, may have changed the trajectory. Disease screening by detection dogs show great promise as a non-invasive, efficient, and cost-effective screening method for COVID-19 infection. We explore evidence of their use in infectious and chronic diseases, the training, oversight, resources required for implementation, and potential uses in various settings. Disease detection dogs may contribute to the current and future public health pandemics; however, further research is needed to extend our knowledge and measurement of their effectiveness and feasibility as a public health intervention tool and efforts are needed ensure public and political support.

To understand operational challenges involved with responding to US measles outbreaks in 2017–19 and identify applicable lessons in order to inform preparedness and response operations for future outbreaks, particularly with respect to specific operational barriers and recommendations for outbreak responses among insular communities.

The worldwide SARS-CoV-2 pandemic has taken a heavy toll on ICUs worldwide. This review expounds on lessons learned for ICU preparedness during the pandemic and for future mass casualty events.

Nuismer and Bull¹ argue for the development of self-disseminating vaccines for cost-effective immunization of animal reservoirs to prevent zoonotic spillovers. The authors suggest two approaches: ‘transferable’ vaccines, non-contagious vaccines applied to animals and spread through behaviour such as grooming, and ‘transmissible’ vaccines, replication-competent virally vectored vaccines with potential for indefinite transmission across populations.

High quality epidemic forecasting and prediction are critical to support response to local, regional and global infectious disease threats. Other fields of biomedical research use consensus reporting guidelines to ensure standardization and quality of research practice among researchers, and to provide a framework for end-users to interpret the validity of study results. The purpose of this study was to determine whether guidelines exist specifically for epidemic forecast and prediction publications.

In response to the protracted Ebola virus outbreak in the Democratic Republic of Congo, the international public health community called for increased attention, coordination, and resources to support the response. The use of real-time modeling and analytics to support public health decision-making (also known as “outbreak science”) has been an important capability that has grown during previous outbreaks [1–3]. Despite the informative role that infectious disease models played in the recent DRC outbreak [4–7], cross-talk within the infectious disease modeling community and between infectious disease modelers and model stakeholders, such as health agencies, may be limited. Lack of communication can reduce the potential use of modeling capability to inform outbreak prevention and mitigation strategies. For example, mathematical modelers may not be aware of questions that would be particularly useful for guiding the response, such as the location and staffing of Ebola treatment units. On the other end, public health teams may not be aware of outbreak features that may signal improvement or worsening of incidence or increased potential for spatial spread.

The human and social toll of the coronavirus disease 2019 (COVID-19) pandemic has already spurred several major public health “lessons learned,” and the theme of effective and responsible scientific communication is among them. We propose that Twitter has played a fundamental—but often precarious—role in permitting real-time global communication between scientists during the COVID-19 epidemic, on a scale not seen before. Here, we discuss 3 key facets to Twitter-enabled scientific exchange during public health emergencies, including some major drawbacks. This discussion also serves as a succinct primer on some of the pivotal epidemiological analyses (and their communication) during the early phases of the COVID-19 outbreak, as seen through the lens of a Twitter feed.

Memish and colleagues,¹in their response to our Comment,² perceive conflict between the current best-practice risk management advice on physical distancing and the scientific evaluation of cancelling or continuing mass gathering events during the coronavirus disease 2019 (COVID-19) pandemic. Although we have already acknowledged the need to balance these two considerations in order to maintain public understanding and trust, we do not accept that conflict is inevitable as our approach requires all mass gatherings to be considered in context, including the prevailing advice on physical distancing and movement restrictions. An open and transparent process to explicitly consider the risks of a mass gathering can, in fact, promote public confidence in the decision.

Mass vaccination is a crucial public health intervention during outbreaks or pandemics for which vaccines are available. The US government has sponsored the development of medical countermeasures, including vaccines, for public health emergencies; however, federally supported programs, including the Public Health and Emergency Preparedness program and Cities Readiness Initiative, have historically emphasized antibiotic pill dispensing over mass vaccination. While mass vaccination and pill dispensing programs share similarities, they also have fundamental differences that require dedicated preparedness efforts to address. To date, only a limited number of public assessments of local mass vaccination operational capabilities have been conducted. To fill this gap, we interviewed 37 public health and preparedness officials representing 33 jurisdictions across the United States. We aimed to characterize their existing mass vaccination operational capacities and identify challenges and lessons learned in order to support the efforts of other jurisdictions to improve mass vaccination preparedness. We found that most jurisdictions were not capable of or had not planned for rapidly vaccinating their populations within a short period of time (eg, 1 to 2 weeks). Many also noted that their focus on pill dispensing was driven largely by federal funding requirements and that preparedness efforts for mass vaccination were often self-motivated. Barriers to implementing rapid mass vaccination operations included insufficient personnel qualified to administer vaccinations, increased patient load compared to pill-dispensing modalities, logistical challenges to maintaining cold chain, and operational challenges addressing high-risk populations, including children, pregnant women, and non-English-speaking populations. Considering the expected availability of a severe acute respiratory syndrome coronavirus 2 vaccine for distribution and dispensing to the public, our findings highlight critical considerations for planning possible future mass vaccination events, including during the novel coronavirus disease 2019 pandemic.