Publications

Since its recognition as a pandemic in early 2020, novel coronavirus disease 2019 (COVID-19) has touched nearly every corner of US society. However, some populations and environments have been affected far more severely than others. Vulnerable populations—especially those subject to structural racism, discrimination due to disability, and financial insecurity—tend also to be particularly susceptible to the economic consequences of and severe disease and death from COVID-19. In addition, the institutions, industries, and systems that are fundamentally important to our lives and our democracy have, in some cases, become places where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads readily if allowed to gain a foothold. In these places, it can be difficult to prevent the introduction of the virus or control the spread of SARS-CoV-2 once it is introduced.

For many children in the United States, the 2020 school year is beginning online, presenting a difficult set of challenges to keep kids learning. The importance of schools goes far beyond the academic benefits of in-person instruction. Schools provide meals, access to health services, and a safe space for students to develop social and emotional skills. Prolonged school closures can jeopardize access to these resources, particularly for the most vulnerable students. School closures also affect parents and guardians. More than 41 million adults were a care provider for a child under the age of 18 in the United States in 2018. During the Covid-19 pandemic, the care of children for many of these adults has collided with work. A survey of working parents in May and June by Northeastern University reported that 13% of the 2,557 participants had to reduce their working hours or leave work entirely to compensate for the loss of childcare availability due to school and childcare closures. Those still working reported an average of eight working hours of the week lost to childcare needs.

Infectious disease outbreaks pose major threats to human health and security. Countries with robust capacities for preventing, detecting and responding to outbreaks can avert many of the social, political, economic and health system costs of such crises. The Global Health Security Index (GHS Index)—the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries—recently found that no country is sufficiently prepared for epidemics or pandemics. The GHS Index can help health security stakeholders identify areas of weakness, as well as opportunities to collaborate across sectors, collectively strengthen health systems and achieve shared public health goals. Some scholars have recently offered constructive critiques of the GHS Index’s approach to scoring and ranking countries; its weighting of select indicators; its emphasis on transparency; its focus on biosecurity and biosafety capacities; and divergence between select country scores and corresponding COVID-19-associated caseloads, morbidity, and mortality. Here, we (1) describe the practical value of the GHS Index; (2) present potential use cases to help policymakers and practitioners maximise the utility of the tool; (3) discuss the importance of scoring and ranking; (4) describe the robust methodology underpinning country scores and ranks; (5) highlight the GHS Index’s emphasis on transparency and (6) articulate caveats for users wishing to use GHS Index data in health security research, policymaking and practice.

The Global Forum on Scientific Advances Important to the Biological Weapons Convention facilitates engagement between scientists performing cutting-edge research and States Parties delegations to the Biological Weapons Convention (BWC). The Global Forum helps the delegates become familiar with some of the rapid advances in the biological and related sciences that affect the treaty and its implementation, and it demonstrates to scientists the role of the BWC in shaping the governance of these technologies. Our efforts to inform BWC delegations on emerging and future biology and biotechnology capabilities supplement an existing portfolio of programs—including the BWC Meetings of Experts and regional science and technology workshops hosted by the InterAcademy Partnership—that work collectively to help States Parties identify and evaluate potential biological threats and develop mechanisms to allow the BWC to remain adaptive to these new capabilities. Additionally, the Global Forum supports efforts, such as model codes of conduct, to foster a culture of responsibility among the scientific community that enables researchers to pursue advanced and revolutionary capabilities while simultaneously encouraging them to account for potential risks and mitigate those effects.

This year, the Global Forum was cosponsored by the Johns Hopkins Center for Health Security and the United Nations Office for Disarmament Affairs (UNODA). The formal involvement of UNODA and the BWC Implementation Support Unit highlights the importance of addressing emerging science and technology in the context of the BWC and the commitment to facilitating engagement between scientists and policymakers to identify and understand emerging biological capabilities and risks.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of novel coronavirus disease 2019 (COVID-19), has caused more than 961,000 known deaths1 since it was reported to the World Health Organization on December 31, 2019. Determining the origin of the pandemic coronavirus is of great importance, not only to understand the mechanics of how the virus replicates and spreads but also to anticipate and prevent additional viruses from becoming future health security crises. If an origin can be found for SARS-CoV-2, steps can then be taken to prevent a similar pathway for other viruses to lead to a pandemic. For that reason, it is the responsibility of the scientific community to review and analyze data relating to the origin of SARS-CoV-2.

The coronavirus disease 2019 (COVID-19) pandemic may have caught governments by surprise, but medical and public health communities have long warned of the potential for a high-consequence pandemic. Most recently, in September 2019, a report by the independent Global Preparedness Monitoring Board urged political leaders to take steps in their countries to improve preparedness for such events.1 One month later, the Global Health Security (GHS) Index, a framework for benchmarking health security in 195 countries, found that no country was fully prepared for a major health emergency.2 The Index identified serious weaknesses in many countries that could undermine their ability to respond to a pandemic, but it did not anticipate the poor response to the pandemic by high-scoring countries such as the US where major gaps in federal leadership resulted in a failure to mobilize the country’s substantial capacity.

We report key epidemiologic parameter estimates for coronavirus disease identified in peer-reviewed publications, preprint articles, and online reports. Range estimates for incubation period were 1.8–6.9 days, serial interval 4.0–7.5 days, and doubling time 2.3–7.4 days. The effective reproductive number varied widely, with reductions attributable to interventions. Case burden and infection fatality ratios increased with patient age. Implementation of combined interventions could reduce cases and delay epidemic peak up to 1 month. These parameters for transmission, disease severity, and intervention effectiveness are critical for guiding policy decisions. Estimates will likely change as new information becomes available.

In The Lancet, Denis Y Logunov and colleagues from the N F Gamaleya Research Institute of Epidemiology and Microbiology in Russia present findings from two phase 1/2, non-randomised, open-label studies of a heterologous, replication-deficient, recombinant adenovirus vector-based vaccine in both frozen and lyophilised formulations. The researchers enrolled 76 healthy adult volunteers (aged 18–60 years) into the two studies (38 people in each study); 53 (70%) participants were men and 23 (30%) were women. The primary outcome measures of the studies were safety and immunogenicity (antigen-specific humoral immunity). In phase 1 of each three-arm study, two groups of nine volunteers received one dose of either recombinant adenovirus type 26 (rAd26) vector or recombinant adenovirus type 5 (rAd5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S), in lyophilised or frozen form. In phase 2, another group of 20 healthy adult volunteers in each study received sequential doses of rAd26-S followed by rAd5-S of one of the two formulations. Adverse events were mostly mild, with the most common adverse events being pain at injection site (44 [58%]), hyperthermia (38 [50%]), headache (32 [42%]), asthenia (21 [28%]), and muscle and joint pain (18 [24%]). Adverse events occurred at similar frequency for each vaccine vector, with each formulation, and after each dose. Serious adverse events did not arise in this small cohort. Both formulations of the vaccine were immunogenic in all participants, inducing neutralising humoral and cell-mediated responses. In phase 2, 85% of participants had detectable antibodies at 14 days after the priming dose, rising to 100% by day 21, with substantial titre rises after the boosting dose.

The world's attention has been drawn to the pace and progress of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) research, as scientists around the world race to better understand the virus and develop therapies and vaccines. While the fruits of this research cannot come soon enough, progress would not be possible were it not for profound advances in biotechnology in the past decade. The progress extends far beyond medical interventions and research tools, it also encompasses advances in agriculture, biological replacements for petroleum chemistry, and a myriad of novel biological products—from spider silk to laboratory grown meats to organic construction materials.^1-3 These myriad endeavors and innovations are part of the “bioeconomy,” which is defined as the economic activity that comes from bio-based feedstock (such as agricultural and forestry biomass), products or materials (like biofuels and chemicals), and processes that contribute sustainable solutions to resolving issues in areas such as food, energy, health, and the environment.^4,5,6 Strategies for developing and supporting national bioeconomies encompass diverse fields, including energy, agriculture, medicine, manufacturing, industrial chemistry, pharmaceuticals, and defense.

An important factor in growing the US bioeconomy is recruiting and training its future workforce. Other science, technology, engineering, and math (STEM) fields have relied on diverse educational opportunities for recruitment, including prestigious high school and collegiate competitions. For genetic engineering and synthetic biology, there are very few competitions; they include the Biodesign Competition and the much larger and scientifically focused International Genetically Engineered Machine (iGEM) competition. iGEM, run by an independent nonprofit organization, is often cited as a measure of progress in developing the synthetic biology workforce. Starting in 2021, iGEM will move its main competitive event, the “Giant Jamboree,” from its long-standing home in Boston to Paris, which is likely to negatively affect participation by the US team. In this article, we describe the value of iGEM to the bioeconomy and its upcoming challenges through a review of available literature, observation of the iGEM Jamboree, and interviews with 10 US-based iGEM team coaches. The coaches expressed positive views about the iGEM process for their students in providing a hands-on biotechnology experience, but they were concerned about the funding US students received to participate in iGEM compared with teams from other countries. They were also concerned that the relocation to Paris would negatively affect or preclude their participation. Possible options to continue the benefits of experiential learning in synthetic biology are discussed, including alternative funding for iGEM teams through a grant process and the need for additional biology competitions.

Since its first appearance in the United States in February 2020, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 3.77 million and killed over 140,000 people in the United States (as of July 20, 2020).¹ Responses to the virus, including closing venues where person-to-person spread was likely (eg, schools, churches, businesses) and requiring the use of masks and physical distancing measures when person-to-person contact could not be avoided, reduced the spread of SARS-CoV-2. At the same time, these protective actions have also radically transformed social life and upended national and household economies.^2,3 As the health crisis continues and pandemic fatigue starts to take hold, political leaders, health officials, and the general public are anxiously searching for solutions.

This report outlines a number of trends that are facilitating advances in different areas of the life sciences, including immunology, neuroscience, human genetics and reproductive science, agriculture and infectious disease. Research and development in these fields is overwhelmingly undertaken for peaceful purposes and potentially provides many benefits to society, the global economy, and future generations. However, the same areas of research raise a number of ethical, legal, safety and security concerns, including concerns that developments therein could feed into of new forms of biological weapons with different and potentially more damaging effects to those of the past.

The COVID-19 pandemic will continue for the foreseeable future, but widespread vaccination could hasten its end. At least 165 candidate vaccines for the SARS CoV-2 virus are in development around the world and there is hope that one or more of these candidates will soon be shown to be sufficiently safe and effective to achieve emergency use authorization in the United States. When a vaccine has been authorized for use, it will initially be in limited supply. During this period of scarcity, a plan is needed for how to allocate and distribute the limited supply—which groups should be prioritized to receive the vaccine first and which groups can wait until later. This difficult and potentially contentious topic is being actively discussed in the United States by the Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC) and the National Academy of Medicine (NAM), as well as globally at the World Health Organization (WHO) and elsewhere. The purpose of this report is to offer an additional ethics framework for use in making decisions about allocation of SARS-CoV-2 vaccine during this initial period of scarcity in the United States and make related suggestions about vaccine distribution. Our approach takes into account considerations of medical risk, public health, ethics and equity, economic impact, and logistics. We note where our approach aligns or differs from the 2018 CDC guidance for vaccine allocation in a severe influenza pandemic, which is the most recent pandemic vaccine guidance from the US government.

On 21 January, California took a major step to increase biosecurity in commercial gene synthesis, introducing legislation that requires all scientists purchasing gene synthesis products to use companies that perform screening on customers and the sequences they order. If enacted, this legislation would make it a competitive advantage for companies to take biosecurity seriously. Here, we argue that the US federal government and other governments should emulate California’s actions.

Enterotoxigenic E. coli (ETEC) and Shigella are enteropathogens causing significant global morbidity and mortality, particularly in low-income countries. No licensed vaccine exists for either pathogen, but candidates are in development, with the most advanced candidates potentially approaching pivotal efficacy testing within the next few years.

To curb the spread of disease and open the economy, the U.S. must implement a national strategy to increase testingof both symptomatic and asymptomatic people while ensuring timely test results. For people with COVID-19 symptoms and people in close contact with known cases, highly accurate laboratory diagnostic tests (“PCR” tests) are required, with results turned around in 24-48 hours to allow effective contact tracing. Better support is also needed for people who face difficulties in isolating if they test positive. For people without symptoms, we also need broad availability of more rapid but sometimes less accuratescreening tests (involving a number of test platforms including pooled PCR, "antigen" tests, and other point-of-care tests) to detect outbreaks sooner and give people more confidence in their workplaces and schools. This is particularly important for high-risk populations such as nursing homes, essential workplaces, and hard-hit communities that currently have limited resources for testing. Financial support for test recipients is needed because screening tests are generally not covered by insurance. Guidance from regulators and public health authorities will also be required on how to use these tests effectively. These tools are needed to control transmission and facilitate safer reopening of schools and workplaces.

Recent infectious disease outbreaks, including the ongoing global COVID-19 pandemic and Ebola in the Democratic Republic of the Congo, have demonstrated the critical importance of resilient health systems in safeguarding global health security. Importantly, the human, economic and political tolls of these crises are being amplified by health systems’ inabilities to respond quickly and effectively. Improving resilience within health systems can build on pre-existing strengths to enhance the readiness of health system actors to respond to crises, while also maintaining core functions. Using data gathered from a scoping literature review, interviews with key informants and from stakeholders who attended a workshop held in Dhaka, Bangladesh, we developed a Health System Resilience Checklist (‘the checklist’). The aim of the checklist is to measure the specific capacities, capabilities and processes that health systems need in order to ensure resilience in the face of both infectious disease outbreaks and natural hazards. The checklist is intended to be adapted and used in a broad set of countries as a component of ongoing processes to ensure that health actors, institutions and populations can mount an effective response to infectious disease outbreaks and natural hazards while also maintaining core healthcare services. The checklist is an important first step in improving health system resilience to these threats, but additional research and resources will be necessary to further refine and prioritise the checklist items and to pilot the checklist with the frontline health facilities that would be using it. This will help ensure its feasibility and durability for the long-term within the health systems strengthening and health security fields.

Community resilience is a community’s ability to maintain functioning (ie, delivery of services) during and after a disaster event. The Composite of Post-Event Well-Being (COPEWELL) is a system dynamics model of community resilience that predicts a community’s disaster-specific functioning over time. We explored COPEWELL’s usefulness as a practice-based tool for understanding community resilience and to engage partners in identifying resilience-strengthening strategies. In 2014, along with academic partners, the New York City Department of Health and Mental Hygiene organized an interdisciplinary work group that used COPEWELL to advance cross-sector engagement, design approaches to understand and strengthen community resilience, and identify local data to explore COPEWELL implementation at neighborhood levels. The authors conducted participant interviews and collected shared experiences to capture information on lessons learned. The COPEWELL model led to an improved understanding of community resilience among agency members and community partners. Integration and enhanced alignment of efforts among preparedness, disaster resilience, and community development emerged. The work group identified strategies to strengthen resilience. Searches of neighborhood-level data sets and mapping helped prioritize communities that are vulnerable to disasters (eg, medically vulnerable, socially isolated, low income). These actions increased understanding of available data, identified data gaps, and generated ideas for future data collection. The COPEWELL model can be used to drive an understanding of resilience, identify key geographic areas at risk during and after a disaster, spur efforts to build on local metrics, and result in innovative interventions that integrate and align efforts among emergency preparedness, community development, and broader public health initiatives.

The impact of the COVID-19 pandemic in the United States has been profound. Despite initial declines in cases in May 2020 following implementation of stringent stay-at-home orders, cases are resurging in most states. The number of deaths has been rising in many states, with hospitalization rates for COVID-19 now again matching or exceeding numbers seen at the peak in New York City in March and April. Hospitals are under pressure or approaching a crisis in many places around the country. This resurgence is stressing many sectors of society, from businesses to education to health care. Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset.

This brief report describes concrete policy actions at the federal, state, and local levels that are needed to get control of the COVID-19 pandemic in the United States.

The Johns Hopkins Center for Health Security, a World Health Organization (WHO) Collaborating Centre on Global Health Security, has worked with WHO on the development of various tools and technical guidance for mass gatherings in the context of COVID-19. The primary aim of this partnership is to encourage stakeholders to use a risk-informed decision-making process when planning for mass gatherings and, specifically, to identify and mitigate the risk of spreading COVID-19 during the mass gathering. This process includes conducting risk assessments to determine the overall risk of disease spread connected to a mass gathering.

In view of the current COVID-19 pandemic, WHO, with the support of the Center and other members of the Novel Coronavirus-19 Mass Gatherings Expert Group, has developed a series of risk assessment tools and other resources for generic as well as sports- and religious-specific mass gatherings. These risk assessment tools include a risk evaluation, mitigation, and communication strategy to aid host countries and organizers of mass gatherings in assessing the specific risk of COVID-19 to their event. A training course has also been created that provides a brief overview of mass gathering planning during COVID-19 and walks users through the use of the risk assessment tools.

Resources for mass gathering planning in the context of COVID-19 can be found at the following link after selecting “COVID-19: Mass Gatherings” from the drop down menu.

Mass Gathering Risk Assessment Tools

1. WHO Mass Gathering COVID-19 Risk Assessment Tool – Generic Events (revised July 10, 2020). Link / Excel Tool
2. WHO Mass Gathering COVID-19 Risk Assessment Tool – Sports Events (revised July 10, 2020). Link / Excel Tool
3. WHO Mass Gathering COVID-19 Risk Assessment Tool – Religious Events (revised July 10, 2020). Link / Excel Tool