Publications

The spread of Zika virus throughout Latin America and parts of the United States in 2016 and 2017 presented a challenge to public health communicators. The objective of our study was to describe emergency risk communication practices during the 2016-2017 Zika outbreak to inform future infectious disease communication efforts.

Many kindergarten through 12th grade (K-12) schools in the United States do not have good ventilation. This is a longstanding problem with demonstrably negative effects on student learning. We can and should act to fix this to ensure good indoor air quality for all students, educators, and school staff. During the COVID-19 pandemic, it is even more important that ventilation problems in K-12 schools be addressed now. Along with other mitigation measures, improvements in ventilation in K-12 schools can decrease the risk of SARS-CoV-2 spread.

The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium—with diverse expertise and representation—representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens’ values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource’s varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes.

The CommuniVax Implementation Toolkit is a guide to help state and local jurisdictions set health equity efforts rapidly in motion, starting with a COVID-19 vaccination campaign that delivers systemic benefits to communities of Black, Indigenous, and People of Color (BIPOC). The toolkit is a product of CommuniVax, a coalition of community advocates, health experts, social scientists, and public sector leaders working together to strengthen state and local COVID-19 vaccination campaigns.

Continuing outbreaks, disasters and active conflict are all evidence that the world remains vulnerable to health emer-gencies with significant health, social, economic and political impacts.1 During the COVID-19 pandemic, even countries considered to have strong health security and strong health systems, as measured by conventional metrics, are struggling to provide routine essential health services. The costs related to the pandemic continue to accumulate, and the world has witnessed excess morbidity and mortality from non-COVID-19 conditions. On stimulus pack-ages alone, countries have spent US$ 15 trillion to mitigate the economic and opportunity costs and reduce the impacts on lives and livelihoods.2

Serology (antibody) tests to detect previous SARS-CoV-2 infection have been in high demand from the beginning of the COVID-19 pandemic. The initial shortage of diagnostic tests coupled with asymptomatic infections led to a significant demand for serology tests to identify past infections. Despite serious limitations on the interpretation of a positive antibody test in terms of immunity to SARS-CoV-2, antibody testing was initially considered for release from social distancing, return to employment, and “immunity passports.” The regulatory approach to antibody tests was limited; manufacturers were encouraged to develop and market antibody tests without submitting validation data to the FDA. FDA guidance grew more stringent, but many poor-quality tests were already on the market—potentially inappropriately used for individual decision-making. This is a case study describing COVID-19 serology tests and the U.S. market and describes lessons learned for a future health security crisis.

Coordination of efforts to assess the challenges and pain points felt by industries from around the globe working to reduce COVID-19 transmission in the indoor environment as well as innovative solutions applied to meet these challenges is mandatory. Indoor infectious viral disease transmission (such as coronavirus, norovirus, influenza) is a complex problem that needs better integration of knowledge. Critical to providing a reduction in transmission is to map the four core technical areas of environmental microbiology, transmission science, building science, and social science. To that end a three-stage science and innovation Summit was held to gather information on current standards, policies and procedures applied to reduce transmission in built spaces, as well as the technical challenges, science needs, and research priorities. The Summit elucidated steps than can be taken to reduce transmission of SARS-CoV-2 indoors and calls for significant investments in research to develop knowledge of viral pathogen persistence and transport in the built environment, risk assessment and mitigation strategy considerations including such as processes and procedures to reduce the risk of exposure and infection including building systems operations, biosurveillance capacity, communication, leadership, and stakeholder engagement for optimal response. The findings reflect the effective application of existing knowledge and standards, emerging science, and lessons-learned from current efforts to confront SARS-CoV-2.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.