Public Health Emergency - Leading a Nation Prepared
Panel Moderator: Mike Shannon, Director at the Office Managment Assessment, National Institutes of Health
Panelists: Dr. James Roth, Distinguished Professor, The Department of Veterinary and Microbiology and Preventative Medicine, College of Veterinary Medicine at Iowa State University and member of the National Academy of Medicine; Dr. William Daresh, Vice President for Health and Policy, EcoHealth Alliance and Interproject Liaison for the USAID emerging threats; Melissa Morland, Biosafety Officer and responsible official for the University of Maryland Baltimore as well as Assistant Director of Environmental Health and Safety.
>> CICELY WATERS: Thank you to our moderator and each of our panelists for goal one. Again, we do appreciate the feedback for those attendees here on site and those participating via webcast, as that truly is the purpose of today's summit, is to solicit and receive your feedback. And as we continue to offer as a reminder, we will continue to receive your feedback in writing, the first official phase through May 1st at ASPRbio@HHS.gov. Our next panel will focus on goal two of the strategy and that goal is to ensure bio defense enterprise capabilities to prevent bio incidents. Our moderator for panel two is Mike Shannon, Director at the Office of Management Assessment with the National Institutes of Health. Mr. Shannon?
>> MICHAEL SHANNON: Good morning. I'll be facilitating the panel on goal two. Goal two focuses on the prevention, the implementation of a prevention strategy and looking forward to avoiding outbreak and spread of naturally occurring and minimized chances of laboratory instances and strengthening our bio security. As Gov. Ridge talked about the more cohesive approach, a non-stove piped approach, responses and strategies to prevent incidences and develop effective countermeasures require that type of agility. Federated thinking doesn't lend itself to an agile response. And goal two focuses on that in a number of areas, promoting and measuring to prevent and reduce the spread of naturally occurring infectious diseases to strengthening global health and security capacities, deter, detect degraded disrupt and deny and otherwise prevent misuse or improper use of these agents. The idea to strengthen biosafety and bio security practices and oversight to mitigate risks. We have a distinguished panel with us today. And they are well suited to assist us in looking at an enterprise view of this activity. Dr. James Roth is a Distinguished Professor in The Department of Veterinary and Microbiology and Preventative Medicine tn the College of Veterinary Medicine at Iowa State University and a member of the National Academy of Medicine. We have Dr. William Karesh. He's Executive Vice President for Health and Policy for EcoHealth Alliance. He serves as an inter-project liaison for the USAID emerging pandemic threats, the predict to program. And Melissa Morland. She's the biosafety officer and responsible official for the University of Maryland Baltimore as well as an assistant director of environmental health and safety. The questions are the same. The subject area of ensuring bio defense enterprise capabilities to prevent bio incidences is our emphasis today. We have our first panel member. We'd like to invite Dr. Karesh to come and join the podium.
>> WILLIAM KARESH: Good morning everyone. Just in all transparency, I was on the New York subway last night and took a train here. I don't know what I brought with me, but we will know in a few weeks whatever I have. I will be sharing with you. I just, I wanted to give a little background in this area of prevention and how we think about it really kind of from the private sector and do quite a bit of research here and I think I have my clicker. I will just jump right into it to save time. I'm going to use that one. Basically this is a transition from panel one into panel two and to thinking about identifying risk factors and prevention because it's very hard to separate those two. I do know that they are discrete activities, but they really help guide us in our prevention efforts. So when we look about disease emergence, emerging infectious diseases whether they are intentional or unintentional, I use this kind of two categories, we see that there are certain risk factors that are highly correlated with what we see as emerging disease events which could be a novel disease or an old disease in a new place, like we've seen recently with Zika in the last couple of years. And what we see is underlying those are things like changes in land use practices, changes in food industry, changes in agriculture. Those really turn out to be the underpinning of most of what we see, the vast majority of what we see. And this is interesting, but we also think of it as being useful, because in prevention strategies, where are you going to target limited resources? You can begin to map out geographically where those activities are occurring, which tend to then be the underlying risks, relative risk between some parts of the world, other parts of the world, some parts of the state, even some parts of the community where we can actually target these things. So this is some work we did early on with the predicting. Some people aren't comfortable with this word, predicting. I think in this case we can't predict when. We don't have a temporal prediction. But we have kind of a more geographical production. Much more like earthquakes, where you see geological factors that make certain areas of the world or certain communities more at risk of earthquakes than others. We see that same trend for infectious diseases because of those underlying risk factors occur in some places more than they occur in others. Now it is a changing landscape. So this, which we put out two years ago, of course changes on a daily basis depending on where those activities are taking place. So if you're in Long Beach County or somewhere in Arizona and land is being converted or changed over from one use to another use, then you're going to see an increased use in those areas versus the stable state. And of course, as people mentioned before, you know, people moving, about 1 billion people are moving internationally just by airline travel every year, so it doesn't even count road travel, road crossings and those things. You can use those same kind of analytics to project which airports are higher risk. Where would we target surveillance systems. Where do we need to be on heightened alert of an emerging disease carried by a human being? On this case, or in their feet or in their clothes or in their baggage. Where are the riskier places there? So we can use this kind of analytics based on those kind of risk factors to actually guide our prevention and target our prevention strategies. So just last week we released a report kind of getting into the kind of second panel movement about what to do about it and where prevention fits in. We do have, I can get you a copy. This is also online if you are on research gate you can pull it online or you can go to eco-health alliance and pull this down and like Gov. Ridge did, I brought a copy to make sure you read this. You should. It's a pleasure. I've been working with him on the blue ribbon panel too. And we look at this prevention category in particular. What we did was very much aligned with the national strategy, which in my opinion is very inclusive and very well thought out, and very well written. And as we are all here today is about the challenge of implementing that. What we took is some of those activities, and I thank my colleague Dr. Ellen Carlin who kind of led this initiative for us and broke down these columns into actual functional activities. Redoing these 15 activities under prevention? Are we doing those activities under detection? Because if you ask any given agency or ministry or particular government and say are you doing prevention? And of course they say yes. But really, are you doing all the functions that are necessary for effective prevention? So we really kind of broke those down and started looking at programs at a global scale of where that is. And you see there's a lot of players, there are a lot of actors. They are government, they are intergovernmental, they are private sector like we are, university, NGOs, and you look at where they are actually investing their money, where they are putting their resources and you break up those categories, you start to see that prevention is pretty weak. And in the strategy, the last panel today will talk about recovery, we also found that that is pretty weak. So, the evidence shows, when you really take an unbiased look at this you start to see that while we all talk about prevention, going back to Ben Franklin an ounce of prevention, we can talk about it, but we don't seem to invest in it. So I would say, my, one of the answers to these four questions, are really driving more investment in this prevention area so we don't have to pay the consequences of responding all the time. So, for my, the kind of questions, and I just kind of broadly hit them for you, the significant gaps are challenges. I think this kind of illustrates that while there is intellectual acceptance of the value of prevention in practice, we don't see a lot of investment there. The money tends to go to response. There is political reasons for that. There's also human nature reasons for that. We as a species don't do a very good job of prevention just in our daily lives. And what are the big high-priority actions under category two? This goal two? I still see it in our last question from the previous panel was about international activity. I don't think we can hide at home. To quote Gov. Ridge again, I don't think we can duct tape up the United States to protect ourselves. If you remember when that was said. Or your home. And we really have to engage overseas and there's some great programs. I mean the US government is probably setting some of the big standards. So we have USAID. We have defense department, DITRA who really reaches out and builds program overseas. So we are very engaged with our counterparts. Who is doing work in the biology sphere around the world. So we get to know them, we build partnerships, we know what they are doing, we build trusts, we build relationships. What are our new initiatives, are the last two questions and proposed initiatives. I will just kind of answer them together because I think for our sector and our organization we say what are we proposing we also think are the most important of course and those are really multisectoral approaches that's really clear in a strategy about linking the human and animal and environment world. So we heard some of that earlier this morning that one of these incidents, yes it can kill people, but as was mentioned, it can also turn into endemic diseases, so what starts out as an introduced little epidemic, a little boom can turn into generations and generations of dealing with new diseases, just as we see diseases move around the world and get established. I think on some of the prevention and analytics, you know there is a big world there for machine learning to refine those activities so we can get better and better. It is some of where to target our resources and prevention. And that international collaboration that I meant before I think is an area that is being supported by the government but really needs I think in prevention we need to reemphasize that we can't deal with any of these problems in isolated state. That we really have to be engaged with our partners around the world. And those can't be, you know, we have to kind of transcend this week's or next week's diplomatic relation. So the biology component of this really has to span generations. We need to be working with countries we get along with well and then some that we don't get along with so well so we can get us prepared for the next decade. Thank you very much.
>> MICHAEL SHANNON: Have a seat. Thank you very much for those insights and comments. Next up is Miss Melissa Morland, the Assistant Director of Environmental Health and Safety will have some insights for us on additional preventions.
>> MELISSA MORLAND: Hi, good morning. I'm honored to be here on behalf of ASPR international and I want first offer abscess full support of the national bio defense strategy and our desire to engage in partnerships toward the success of this effort. So, each of these strategies five goals include objectives in which biosafety and bio security professionals currently function and could contribute. However, goal two is a particular interest as it accurately defines the overarching goal of the biosafety profession. We were asked to focus on gaps in our business sector and initiatives planned to fill gaps in preventing bio incidents. So we first identified training, which has already been brought up here today but specifically building a culture of biosafety, our culture of responsibility early in a career. Academic institutions conduct just under half of the nation's basic research. But more importantly, they train young researchers in the process. Many field research projects are on emerging and infectious diseases globally are partnerships between US academic institutions and foreign countries, however many undergraduates and even graduate students lack rigorous training in biosafety. They don't understand the risks present or how to protect themselves from those risks. We continue to look for ways to address that gap and to raise awareness at the collegiate level. ABSA international, through partnership with biosafety and bio containment training program developed a curriculum package for the education of undergraduate science students in the discipline of biological safety. This course would also be appropriate for graduate, medical, nursing, public health, medical technology students and other life science degrees. In addition, ABS a international continues to work on increasing awareness in our clinical labs. We have a representative on the ABHL biosafety and bio security forum focused on integrating biosafety into a public health labs and clinical labs. We also offer an intensive five day hands-on training course on principles and practices of biosafety, release twice yearly. The second gap identified is related to bio security. ABS a international is the Association for biosafety and bio security. As science becomes more interdisciplinary, recognizing and defining the synergistic roles of biosafety and bio security professionals has never been more paramount. ABSA currently supports an international credentialed workforce with expertise in mitigating biosafety risks associated with life sciences, research, pharmaceutical production, education and other industries. ABS a recognizes that as technology advances, and national security remains a concern there's a substantial and ever increasing need for biosafety professionals to focus on bio security. ABS a is taking the lead on this vital issue by holding a 2020 bio security symposium and instituting a professional bio security credential to establish a common base of technical knowledge and a foundation on which to advance thoughtful leadership. ABS a international's bio security symposium will bring together bio security professionals from a wide range of disciplines with varying expertise to share their experiences, knowledge and to learn from each other. The agenda will focus on agricultural and food safety, cyber security, personnel reliability, physical security, responsible communication and research that can be potentially misused. And our last gap identified is the development of sustainable programs in low income countries. ASPR international currently has over 1500 members representing 27 countries and we have credentialed over 440 biosafety professionals internationally. We continue to look for ways to reach our international members. We have just instituted a new membership category for low income countries and we offer a free basic biosafety on demand course. 39 countries were represented at our last ASPR symposium and 31 at the ARS symposium. These conferences are the most significant gatherings of biosafety professionals globally. Continued support and funding for attendance is imperative to continue building sustainable biosafety and bio security capacity globally. A dollar figure cannot be put on the informal mentoring and relationships that develop during these meetings. The professional generosity of the biosafety field is incomparable to any other. I have had the honor of working as an international mentor for the past seven years. The difference one can make in a short period of time is amazing. I hope that funding will continue for all these opportunities to help minimize the chances of bio incidents by strengthening biosafety and bio security practices globally. Thank you.
>> MICHAEL SHANNON: Thank you, Melissa. It's difficult to not read all of the background and experience and areas of expertise that our panel have. I wish there was time to do that. But I think from their comments and the comments that will come from the discussion you will find that we really do have a good cross level of enterprise opportunity, and to that end, Dr. Roth, the Distinguished Prof. at the Department of Veterinary and Microbiology and Preventative Medicine at the College of Veterinary Medicine at Iowa State. Dr. Roth? Oh, he is behind me.
>> JAMES ROTH: Thank you. I'm very pleased to be here. And especially pleased to be able to represent... I need slides, animal agriculture perspective for this bio defense symposium. I may be biased, but my view is that animal agriculture doesn't get the attention it needs and the bio defense arena. Animal agriculture is, I did have some slides, I think. There we go. The challenges for animal agriculture is very different than for human bio defense. We know what the greatest threats are, and they are common in other countries. We do expect animal diseases to respect national boundaries. We don't expect human diseases to. Animals cannot move between countries without health certificates, and usually a period of isolation and quarantine in order to prevent animal diseases from spreading across countries. They can be easily introduced through international travel, wherein people bring in illegal things they shouldn't bring in, trade with contaminated items. In the US mail, or even intentionally. It requires no expertise or equipment to bring in animal diseases because they are so common in many other countries. Recent examples of big outbreaks, in 2013 we had an outbreak of porcine epidemic diarrhea virus. It was common in other parts of the world. We had never had it. Probably came in with contaminated feed ingredients from China and killed 8 million baby pigs in the first year and is still a continuing problem for the swine industry. 2015 we had a high pathogenic avian influenza outbreak, age 5 n2 fortunately it was not zoonotic. It arrived from Asia. Overall killed 50 million poultry in the US. Iowa was the epicenter. We lost 30 million poultry in a two-month period. And that illustrates how quickly these diseases can ramp up in animal populations. If this had been zoonotic, it would have been much much more difficult to control. Cost the Iowa economy about $1.2 billion. The federal government about $1 billion to get it under control. And also all the CDC listed bioterrorism agents except smallpox affect animals. So whether the agent comes in to people first or animals first, it's going to have to be dealt with in animals, whatever species are infected by that particular agent. Next slide. So I will address the four gaps very briefly. The four questions we are asked to address. Given the demonstrated failure to keep porcine epidemic diarrhea virus and high pass avian influenza out of our animal populations we really need to focus on rapid recognition and rapid response. It is an awfully big task to try and keep these diseases out as we are seeing. We need to find them quickly and be prepared to deal with them quickly. And fortunately with avian influenza we were able, the federal government, state governments industry and academia were able to get it under control with a very vigorous response, helped by the fact that avian influenza usually goes away in the summer. The weather got warmer and the virus was brought under control with a lot of great effort. There are other diseases out there, such as foot and mouth disease, African swine fever and classical swine fever that would be far worse for the economy than PED, or high pass avian influenza. It is estimated that an outbreak of foot and mouth disease which affects all cloven hoped animals would cost over $2 billion in a 10 year period. And also most people that are familiar with the situation believe we won't be able to, we would be very fortunate if we could get it under control and not have it get out of control because it's highly contagious. African swine fever right now is causing devastation in China. It is believed, it's estimated to perhaps wipe out 20 to 30% of all pork production in China. We don't have hard figures on that. China is half of the pigs in the world. If it wipes out 20 to 30% of their production, all the pigs produced in US, Canada and Brazil wouldn't be enough to replace what they will lose. So it's a very significant food security issue. For an action we need increased investment in inspections for illegal animal products at ports of entry, international mail that is arriving and all trade goods imported to the US, that is of course an extremely large task. Next slide. New initiatives. We've been working on secure food supply plans funded by the USDA, working with USDA state officials, academia and the industry to come up with plans for how we would deal with these diseases and get them under control without stamping out the animal agriculture in the process. We've got to continue food production so we have food security and how would we manage these diseases if they come in. Another new initiative in the 2018 farm bill, funding for the national veterinary stockpile, which is a stockpile of vaccines and other countermeasures, the national animal health laboratory network, nearly every state has a national animal health laboratory, and preparedness at the state level. It was funded at $30 million a year for five years. Spread among those three initiatives. However, the livestock and poultry industries will be very hard to get $250 million a year for a good start on these three things that need to be funded. Before the farm bill was funded we had about $2 million a year for the national veterinary stockpile. For 90 million cattle, 60 million pigs and over 1 billion chickens a year compared to the funding for the human stockpile. So we really need to increase that investment. And that's what I have for you.
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