Publications

Since the emergence of the SARS-CoV-2 virus in late 2019, the world has been in a state of high alert and reactivity. Once the acute stage of the infectious disease crisis does abate, however, few if any communities will have a detailed roadmap to guide recovery – that is, the process of becoming whole again and working to reduce similar, future risk. In both research and policy contexts where data are absent or difficult to obtain, expert judgment can help fill the void. Between November 2019 and February 2020, we conducted an expert elicitation process, asking fourteen key informants – with specializations in infectious diseases, disaster recovery, community resilience, public health, emergency management, and policymaking – to identify the design principles, priority issues, and field experiences that should inform development of an epidemic recovery model. Participants argued that recovery from epidemics is distinct from natural disasters due to epidemics’ potential to produce effects over large areas for extended periods of time and ability to generate high levels of fear, anticipatory anxiety, and antisocial behavior. Furthermore, epidemic recovery is a complex, nonlinear process involving many domains – political, economic, sociocultural, infrastructural, and human health. As such, an adequate model of post-epidemic recovery should extend beyond strictly medical matters, specify units of interest (e.g., individual, family, institution, sector, community), capture differing trajectories of recovery given social determinants of health, and be fit for use depending upon user group (e.g., policymakers, responders, researchers). This formative study commences a longer-term effort to generate indicators for a holistic, transformative epidemic recovery at the community level.

The US Food and Drug Administration (FDA) granted Emergency Use Authorization for Pfizer-BioNTech’s mRNA COVID-19 vaccine (BNT162b2) for children 5 to 11 years of age on October 29, 2021. The Centers for Disease Control and Prevention recommended use of the vaccine among children in this age group on November 2, 2021. Approximately 28 million children are now eligible for vaccination, with only those younger than 5 years remaining excluded from vaccine eligibility. The benefits of pediatric COVID-19 vaccines are clear. Vaccinations protect children, decrease spread to families and communities, and ensure educational continuity. What do parents, practitioners, and policy makers need to know about pediatric COVID-19 vaccines?

The COVID-19 pandemic has revealed that a true, end-to-end research and development (R&D) and response ecosystem—meaning, one that develops, produces, and delivers needed vaccines to global populations in a rapid and equitable fashion—remains an elusive goal. Most low- and middle-income countries (LMICs) have been unable to acquire and administer a sufficient supply of COVID-19 vaccines, and the dearth of vaccines and limited capacity to deliver them are prolonging the pandemic and contributing to destabilizing economies and societies around the world. Multilateral initiatives, bilateral aid, and vaccine donations, though useful, have been slow to arrive and insufficient to provide adequate vaccine coverage for LMIC populations. The consequences of this deeply inequitable global response extend beyond the COVID-19 pandemic. Global initiatives to prepare for and respond to future pandemic threats cannot succeed if LMIC governments believe they will be the last to benefit from vaccines produced as a result of improvements in global disease surveillance, increased sample sharing, or expedited vaccine R&D.

The 20th anniversary of the terrorist attacks on September 11, 2001, resulted in deep national reflection. Less remembered are the events that began to unfold 7 days later as anonymous letters laced with deadly anthrax (Bacillus anthracis) spores began arriving at postal facilities, media companies, and congressional offices. The first death from inhaled anthrax exposure occurred on October 5, with an additional 4 deaths and 17 infections over the ensuing months.¹ The anthrax attacks exposed a health system ill-equipped to respond to acute emergencies.

The COVID-19 pandemic has shown that false or misleading health-related information can dangerously undermine the response to a public health crisis. These messages include the  inadvertent spread of erroneous information (misinformation) or deliberately created and propagated false or misleading information (disinformation). Misinformation and disinformation have contributed to reduced trust in medical professionals and public health responders, increased belief in false medical cures, politicized public health countermeasures aimed at curbing transmission of the disease, and increased loss of life.

The importance of infectious disease epidemic forecasting and prediction research is underscored by decades of communicable disease outbreaks, including COVID-19. Unlike other fields of medical research, such as clinical trials and systematic reviews, no reporting guidelines exist for reporting epidemic forecasting and prediction research despite their utility. We therefore developed the EPIFORGE checklist, a guideline for standardized reporting of epidemic forecasting research.

For the US, COVID-19 testing is here to stay. The White House’s “Path out of the Pandemic” announcement on September 10, 2021 calls for increased access to COVID-19 testing and testing programs, including for schools and for employees of businesses larger than 100 people who are not vaccinated.(1) To increase the availability of tests, the Defense Production Act has been invoked by the Administration to increase manufacturing, free pharmacy testing has been expanded, and home rapid antigen tests will be sold at reduced prices by major retailers. This plan is a welcomed ramp-up of testing capacity which will help address current shortages of tests and long delays in getting test results. It will be important, however, for the US government to not only address the current demands for testing but to anticipate what testing needs are likely for the future, and plan for them. Testing needs are increasing and will change—though not disappear—when cases of COVID-19 eventually decline.

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.