New and improved medical treatments for infectious diseases are vital to improving global health security; however, public education is equally important. Myths and misperceptions regarding infectious diseases have detrimental effects on global health when a disease outbreak occurs. While it may seem that this problem is isolated to remote regions of the developing world, neither infectious diseases nor misconceptions regarding them are explicitly confined to certain areas.

Outbreaks can be highly disruptive to the movement of people and goods, often leading to increased regulations and restrictions on travel and trade to reduce the potential for further spread of disease. The Severe Acute Respiratory Syndrome (SARS) epidemic in 2003 was but one of the numerous examples in which international travel was disrupted. The disease quickly infected thousands of people around the world and disrupted national economies. Due to the rapid transmissibility of SARS, the World Health Organization (WHO) issued a travel advisory in effort to reduce the international public threat. In 2001, the United Kingdom experienced a detrimental hit to the agricultural sector as foot-and-mouth disease spread throughout livestock. Because of the highly transmissible nature of the disease (which affected cattle, pigs, sheep, and goats), the government banned all exports of live animals, meat, and dairy products in an effort to mitigate the spread of the disease and on February 24, mass slaughtering of pigs and cattle began. Later that same year, the tourist industry estimated that businesses lost nearly £250 million ($421 million U.S. dollars).

In the developing world, pneumonia, diarrhea, malaria, measles, and HIV/AIDS are some of the primary causes of death, especially among children. This is in part attributable to socioeconomic factors that prevent people from having access to routine health services and immunizations. Poor nutrition and unsanitary living conditions also place people at-risk. In Africa, the death rate among children from measles, a viral respiratory disease, has reached an average rate of one per minute. Measles weakens the child’s immune system, rendering them susceptible to further fatal complications such as diarrhea, pneumonia, and malnutrition. Yet, in the developed regions of the world, measles is commonly treated through immunizations.

Tetanus, an infection caused by the bacteria Clostridium tetani (which is ubiquitous in the soil), is common in developing areas that continue to practice unsanitary medical techniques during procedures such as child birth, circumcision, and use of contaminated medical bandages during such procedures. While proper sanitary resources are scarce in these regions, it is evident that the lack of supplies is not the only cause of disease transmission as proper sanitation techniques could have mitigated transmission. Due to the lack of education and misinformation regarding public health, sanitation, and the mechanisms of disease transmission, the spread of infectious diseases like tetanus continues.

Developed countries are also susceptible to infectious disease outbreaks despite modern medical advances and technology. Disease outbreaks in developed regions have been due in part to the misconceptions of vaccines and anti-bacterial drugs that have been used to deter the spread of infectious diseases. While some individuals have the perception that antibiotics are a “cure-all” drug, their effectiveness is only on infections caused by bacteria, not viruses. When improperly used (for example- taking when they are not needed, ingesting the wrong type of antibiotic or one that is not of the proper dose), the bacterial cells that survive can result in reinfection or the emergence of an antibiotic-resistant strain of the bacteria. This was evident in the recent reemergence of pertussis, also known as “Whooping Cough,” in the mid-1970s when Great Britain, Sweden and Japan reduced their usage of the pertussis vaccine as there was a common fear of vaccinations. The effect was immediate and drastic- there were over 100,000 cases and 36 deaths in Great Britain, 13,000 cases and 41 deaths in Japan, and 3,200 cases in Sweden. The United States witnessed a similar outbreak in the northwest region of the country in 2012, when over 17,000 cases emerged shortly after an increased rate of vaccine refusals for pertussis. While no vaccine is 100% effective, it is evident that popular misconceptions regarding infectious diseases and their spread can have detrimental repercussions on the populace and need to be addressed head-on.

Education, early detection, and access to are all essential in containing and preventing the spread of disease in a globalized society. Myths and misconceptions have hindered the effectiveness of vaccinations, as individuals have become skeptical of their effectiveness. However, vaccinations can drastically reduce the chances of contracting many diseases. Additionally, developing and utilizing programs that educate the public regarding the implications of infectious diseases and treatments pertaining to them, the spread of disease is likely to be significantly reduced.

Infectious disease outbreaks are a significant threat to global health security and thus have the potential to impact nearly every facet of daily life. Even in an era of medical advancements, increased sanitary practices, and knowledge of microbes, infectious diseases are still prevalent throughout the world. While having better medical practices and medicines available is beneficial in combating the transmission of infectious diseases, there is no substitute for better public health education.

U.S. National Library of Medicine. “Severe Acute Respiratory Syndrome (SARS).” Last Modified Jan. 28, 2013. Accessed March 20, 2014. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004460/

Eco Health  Alliance. “7 Common Myths About Pandemics and New Diseases.” Last modified June 27, 2013. Accessed on March 19, 2014. http://www.ecohealthalliance.org/blog/99-7_common_myths_about_pandemics_and_new_diseases

BBC. “Foot-and-Mouth Crisis Remembered.” Last modified February 17, 2011. Accessed on May 13, 2014. http://www.bbc.com/news/uk-england-12483017

UNICEF. “Immunization: Why Children Are Dying.” Accessed on March 19, 2014. http://www.unicef.org/immunization/index_why.html

Medical News Today. “What is Tetanus? What Causes Tetanus?” Last modified Sept. 4, 2009. Accessed on March 19, 2014. http://www.medicalnewstoday.com/articles/163063.php

Mayo Clinic. “Antibiotics: Misuse Puts You and Others at Greater Risk.” Last  Modified 2014. Accessed March 20, 2014. http://www.mayoclinic.org/healthy-living/consumer-health/in-depth/antibiotics/art-20045720

Koo, Ingrid. About.com, “The Truth About Antibiotics.” 6 Nov. 2008. 6 Apr. 2014. http://infectiousdiseases.about.com/od/treatment/a/antibiotic_myth.htm

Center for Disease Control. “Some Common Misconceptions About Vaccination and How to Respond to Them.” Last modified Feb. 18, 2011. Accessed on March 19, 2014. http://www.cdc.gov/vaccines/vac-gen/6mishome.htm

Forbes. “Anti-Vaccine Movement Causes The Worst Whooping Cough Epidemic in 70 Years.” Last Modified July 23, 2012. Accessed on March 19, 2014. http://www.forbes.com/sites/stevensalzberg/2012/07/23/anti-vaccine-movement-causes-the-worst-whooping-cough-epidemic-in-70-years/

Mayo Clinic. “Infectious Diseases.” Last modified    Jan. 23, 2013. Accessed on May 23, 2014. http://www.mayoclinic.org/diseases-conditions/infectious-diseases/basics/prevention/con-20033534

Brittany Linkous is a graduate of King University with a double major in Cellular and Molecular Biology and Political Science and History, and a minor in Security and Intelligence Studies. While at King, she served as Executive Officer of the King Security and Intelligence Studies Group and Executive Editor of the Security and Intelligence Studies Journal. She also interned in Washington, DC, at the William J. Perry Center for Hemispheric Defense Studies at the National Defense University, and the Federation of American Scientists. In the fall of 2014, Brittany will be entering the Biodefense Program at George Mason University.

Global biosecurity engagement programs are designed to prevent the harmful use of biological agents and pathogens. It is difficult to measure the effectiveness of these programs in improving biosecurity given that there have been relatively few attempts to misuse the life sciences. Metrics that focus on outputs (what was done) as opposed to outcomes (the impact of what was done) have not been helpful in determining how these efforts might be improved in the future. As a result, the goals of the programs have traditionally been more quantitative in nature – for example, increasing the number of agents secured and number of scientists engaged. Broadening the scope of biosecurity engagement metrics can help align program goals with a more qualitative approach that prioritizes the international partners’ global health security.

To understand how biosecurity engagement is conducted and evaluated, Michelle Rozo, Ph.D. candidate at Johns Hopkins University, interviewed more than 35 individuals in the United States and abroad (including government officials and their non-governmental partners) regarding current and future programs that can be used to create a cohesive, global health system approach to biosecurity. The results from the interviews are complied in an issue brief which also provides a strategy for policymakers to focus more on qualitative public health outcomes instead of quantitative security outputs. With this strategy, programs will cost less and be more effective in reducing global threats.

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The Highly Pathogenic Avian Influenza (HPAI) H5N1 virus poses a public health threat in many regions of the world. Approximately 600 human cases have been reported since 2003, with a laboratory-confirmed case fatality rate of up to 60% according to the World Health Organization (WHO). The recent death of a woman from southwest China, attributed to H5N1, has sparked concerns with public health officials that the strain can now be transmitted between humans. Typically, H5N1 is contracted by people in direct contact with poultry. Health authorities in Guiyang, Guizhou province concluded that two patients, including the woman who died, did not have contact with poultry before showing symptoms of the illness. Currently, the public health community remains cautious as H5N1 influenza viruses continue to evolve and potentially gain the ability to be transmitted efficiently to humans. One of the objectives for H5N1 research is to identify genetic changes that are linked to transmission or enhanced virulence in mammals. This information may lead to improved pandemic preparedness efforts such as development of better vaccines, antivirals, and diagnostics for H5N1 strains that have the potential to spread among humans.

Similar to other research experiments involving infectious pathogens, some H5N1 studies, due to their inherent dangers, are described as Dual Use Research of Concern (DURC). Biosafety risks include laboratory-acquired infections or accidental release of the virus, which are major threats for public health. In fact, last year, researchers around the world took the remarkable step of imposing a moratorium on “gain-of-function” experiments due to concerns about public health risks. The following provides answers to basic questions about the risks of this type of research, the status of the moratorium, and what steps are being taken to mitigate future public health risks.

What are “gain-of-function” experiments?

A “gain-of-function” experiment introduces or amplifies a gene product. This type of research is intended to increase the transmissibility, host range, or virulence of pathogens. Most “gain-of-function” experiments are used to examine the subtle complexities of biology. The gene products of the majority of these experiments result in cellular death or with phenotypes that are difficult or impossible to interpret. Specific to H5N1 influenza research, it is hoped that enhancing and analyzing the transmissibility of the pathogen could provide new information that could lead to improved vaccines to prevent an outbreak that may arise in the future. However, there is also risk that it could lead to an inadvertent release of a virus with enhanced transmissibility.

Why were they ceased?

The H5N1 influenza virus research was temporarily ceased in January 2012 due to the risks involved with disseminating experimental results that could be used for nefarious purposes. All research on H5N1 transmission was halted after laboratories at the University of Wisconsin and the Dutch Eramus Medical Center in Rotterdam, Netherlands created mutant forms that could be transmitted directly among ferrets. This was concerning because viruses that are easily transmissible between ferrets are often also easily transmissible between humans. Some experts argued that the benefits of this kind of H5N1 research to health and medicine were overhyped and not worth the risk of an accidental release that would expose the public to these mutant strains.

Bioterrorism, biosafety, and regulatory issues have also been brought to light since the initiation of the year-long voluntary moratorium. Many scientists fear that the scientific details on creating a potentially dangerous virus could be used for bioterrorism. Researchers claim that the experiments have the potential to lead to public health benefits but have also exposed regulation gaps on dual-use research. The public health benefits include: influenza surveillance that catches infectious strains early, better drugs, and improved vaccines. Yoshihiro Kawaoka of the University of Wisconsin and Ron Fouchier of Erasmus University in the Netherlands, both leading H5N1 researchers, argued the fears were overblown and surpassed by the potential public health preparedness their studies may lead to.

Has there ever been a similar moratorium before for other experiments?

This is not the first time that scientific research has been suspended due to security concerns. In July 1974, a call for a voluntary moratorium on research using emerging recombinant DNA (rDNA) technology stunned the scientific community. American scientists were concerned that unrestricted pursuit of this research might produce unanticipated and damaging consequences for human health and the ecosystem. Despite widespread apprehension, the moratorium was collectively observed worldwide. The 1975 Asilomar Conference on Recombinant DNA – named after the Asilomar Conference Center in California, where it was held – marked the beginning of a unique era for the public discussion of science policy. The major goal of the conference was to consider whether to lift the voluntary moratorium and, if so, under what circumstances could the research proceed safely. The moratorium was enacted by scientists and governments to protect laboratory personnel, the general public, and the environment from potential hazards that might be directly generated from rDNA experiments. During the conference, recommendations were established for how to safely conduct experiments using rDNA. The debate on potential biohazards was the primary focus of the conference, which is still a continued discussion in biotechnology today.

The conference also highlighted the fact that policy and regulations have both private and public stakeholders. Although the conference was primarily run by molecular biologists, the debate resulted in other scientists and non-scientists joining national and local review boards. Also resulting from the Asilomar Conference was membership expansion of the Recombinant DNA Advisory Committee (RAC) to 16 members in fields to include experts from: molecular biology, genetics, virology, microbiology, epidemiology, infectious diseases and the biology of enteric organisms. The purpose of the RAC was and is to promote transparency and access for all stakeholders, enabling public approval of critically important technology, and creating an environment in which scientific research can be performed in an informed, safe, and ethical manner.

How many researchers/countries are involved in “gain-of-function” experiments?

The letter that announced the voluntary moratorium on H5N1 transmission research, published in Science and Nature, was signed by 40 leading influenza researchers from the United States, China, Japan, Britain, the Netherlands, Hong Kong, Germany, Italy, and Canada. Everyone, in some way, may be affected by “gain-of-function” experiments. The “gain-of-function” experiments have a plethora of stakeholders within the international community. In December 2012, the United States hosted the “Gain-of-Function Research on Highly Pathogenic Avian Influenza H5N1 Viruses: An International Consultative Workshop.” This workshop integrated experts in various fields, including: influenza and other infectious diseases, bioethics, public health surveillance, biosafety, national and global public health, biosecurity, epidemiology, national security, agriculture and veterinary sciences, global public health law and those specifically involved with developing the WHO International Health Regulations and the Pandemic Influenza Preparedness Framework, and medical countermeasures to disease outbreak. While the purpose of the moratorium was primarily to take time to discuss risk/benefit analysis of gain-of-function experiments, another important consideration was how to educate the public and gain their acceptance for continued research.

What new steps are being taken to minimize the risk of H5N1 research to public health?

The RAC of the National Institutes of Health (NIH) has called for additional precautions on H5N1 “gain-of-function” experiments that are conducted strictly in biosafety level 3 (BSL-3) laboratories, which have been used in recent studies on H5N1 transmissibility. The committee has rejected the option of restricting research to facilities designated as BSL-4 – the highest level of biosafety laboratories – because only a few laboratories around the world would meet this standard. Limiting H5N1 research to only these labs would slow the pace of discovery. Additionally, many experts argue H5N1 experiments can safely be done in BSL-3 with enhanced safeguards. Existing BSL-3 laboratory requirements include: powered air purifying respirators (PAPRS), donning a protective suit, wrap-back disposable gowns, double gloving, shoe covers, and a shower before exiting the laboratory. The recommended steps are aimed at reducing the risk of laboratory-acquired infections and the accidental release of the dangerous pathogens. The additional requirements devised recently by the RAC include: increased personal protective equipment (PPE), a “buddy system” for all personnel, maintaining baseline serum samples, providing a licensed H5N1 vaccine, and requiring personnel to avoid contact with susceptible bird species for five days after working with the viruses. The RAC also recommended proper training of lab personnel would be essential and recommended that personnel be required to sign a statement confirming that they understand the safety and incident-reporting requirements. Additionally, the RAC recommended that all incidents that have the potential to be harmful to personnel and/or the public be reported to institutional authorities immediately and to public health officials within 24 hours.

What are the recommended next steps for the United States concerning the recent moratorium?

Although the H5N1 international research moratorium was lifted in January 2013, the United States has yet to resume research involving gain-of-function experiments on the H5N1 virus and is currently designing a framework for the Department of Health and Human Services (HHS) to make judgments about funding for this type of research. This framework will provide HHS’ funding agencies with guidance on how to classify potentially high-risk gain-of-function projects at the funding proposal stage and make determinations as to whether they are acceptable for HHS funding. For the proposals that are deemed acceptable for funding, the framework will also establish a basis for HHS’ funding agencies to designate any additional biosafety, biosecurity, and DURC risk mitigation measures that they will require of researchers.

With China’s February report of two new human cases of H5N1, the debate of moving forward with “gain-of-function” research remains of upmost importance for global public health. In light of the new cases, researchers are insistent to resume experimentation on the deadly virus in hopes to produce results for prevention or new countermeasures. But the dangerousness of the virus underscores the importance of prioritizing safety when carrying out this research, even if it means pausing for a moment to make sure experimentation does not inadvertently create more problems than it solves.

Malerie Briseno is a Biosecurity Intern at the Federation of American Scientists. She graduated from Georgetown University’s School of Medicine with a M.S. in Biohazardous Threat Agents and Emerging Infectious Diseases.

Christina England is currently a Masters Candidate from the University of Maryland School of Public Policy, specializing in International Security and Economic Policy.  She is serving as a biosecurity intern at the Federation of American Scientists, overseeing its Virtual Biosecurity Center.  She graduated from the United States Air Forces Academy as distinguished graduate, receiving her BS in Biochemistry.

It was reported this week that the Presidents Council on Bioethics was disbanded. The Council, appointed by the Bush Administration, was often accused of taking a more ideological than scientific perspective in its reports and advice. In its place, President Obama will convene a new bioethics commission.

Today Science Magazine is reporting that the Army has banned all pathogen research at one of its labs at the Armed Forced Institute of Pathology (AFIP) in Washington, DC. This decision was made December 2, 2008 as a result of an earlier failed Biological Surety Inspection, and not made public.

Science reports that “officials found that lab managers ignored information about certain employees that could have disqualified them from having access to dangerous pathogens. The redacted version of the IG’s [Inspector General’s] report released to Science does not divulge the nature of this so-called potentially disqualifying information, but it could be anything from alcoholism to mental instability.”

On October 28, 2008 AR 50-1 came into effect, stipulating a strict Biological Personnel Reliability Program for DOD employees as part of their Biological Surety Program. It includes and intense background investigation and interviews  of employees as well as regulations regarding substance abuse and mental health.

In early February the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) also suspended its research on biological select agents and toxins when it was realized that there were problems with the system of accounting for high risk microbes and biological materials in the laboratories at Fort Detrick, MD.

Today at 1pm EST HHS secretary Kathleen Sebelius, DHS Secretary Janet Napolitano and acting Director of the CDC Richard Besser will be webcast answering questions about Swine Flu from the American people.  The webcast will be available at www.hhs.gov and questions can be emailed to hhsstudio@hhs.gov.

The World Health Oraganization has now raised the Pandemic Alert Level to Phase 5 meaning that they believe there is a “strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.” There currently have been 109 confirmed cases of Swine Flu in the US and one death. Continually updated information on the situation and statistics as well as fact sheets and interim guidance documents can be found on the CDC Swine Flu page at www.cdc.gov/swineflu.

SciecneInsider has the details surrounding an Ebola researcher who pricked her finger with a needle during an experiment last week. Virologists around the world are collaborating to try to save their colleagues life. An exposure to Ebola from a needle stick does not often lead to infection with the deadly illness, but a group of scientists immediately got together to discuss a long list of experimental vaccines and treatments that could possibly prevent infection or slow progression of the disease. As a result, the exposed researcher was given a vaccine that has previously been shown to provide protection in monkeys who had been exposed to Ebola. The incubation period of Ebola is typically between 4 and 21 days, and it has only been 6 days since the needle stick incident. Thus far there is no indication that the researcher has contracted an Ebola infection, but virologists are anxiously following her case.

On March 12 AAAS in partnership with the Center for Biosecurity of UPMC hosted a public briefing to discuss the current oversight of high-containment laboratories. The session was held to discuss the elements of H.R. 1225, the recently introduced Select Agent Program and Biosafety Improvement Act of 2009. This bill seeks to reauthorize the Select Agent Program by amending the Public Health Service Act and the Agricultural Bioterrorism Protection Act of 2002 and to improve oversight of high containment laboratories.
Michael Ehret from the Midwest Research Institute, a private laboratory, Michael St. Clair, from Ohio State University an academic laboratory, and Michael Pentella from the University of Iowa, a public health laboratory discussed the regulatory procedures associated with the operation of each of their facilities. Each spoke about the different agencies and number of inspections or audits that they face each year, the costs of these audits and staff training as well as additional personnel reliability programs in place at their institutions.
All three speakers expressed concern about the number of agencies, each with a unique set of regulations, responsible for oversight of their facilities and suggested that a harmonized approach to regulation was necessary. Each of the represented laboratories also had internal oversight committees to ensure a high level of safety and security.

During a ceremony at the White House today, President Obama signed an Executive Order to overturn President Bush’s 2001 restrictions on using federal funds for research on embryonic stem cells. The Executive Order is focused on stem cell research, but it signals a desire by the Obama Administration to return scientific integrity to its policy decisions. Accompanying the Executive Order will also be a Presidential Memorandum to ensure that the government’s scientific decisions are insulated from political influence. This is a welcome change after 8 years of the Bush Administration ignoring or distorting science to further its political agenda.

Yesterday Interfax news agency reported that experts estimate that over 30 nations have the capability to rapidly deploy biological weapons. The remarks were made by Natalya Kaverina of the Russian Academy of Sciences’ Institute of Global Economy and International Relations during a presentation for the Stockholm International Peace Research Institute on March 3. Kaverina suggested that the tempation to use such weapons had inreased due to global instability and economic uncertainty.

This weekend it was reported that 2 mice infected with Yersinia pestis, the causitive agent of plague, were missing from a lab at the University of Medicine and Dentistry of New Jersey (UMDNJ). In September 2005 it was also reported that 3 live mice infected with Y. pestis were missing from UMDNJ a lab. In this case however, the “missing mice” are actually the carcasses of mice who died during an experiment, were bagged and placed in a freezer for storage until the experiment was completed and they could be incinerated. It is believed that the missing bag of mice was accidentally sterilized along with another bag.

In both cases the FBI investigated and determined that there was no public health risk.

ScienceInsider is reporting that the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) has suspended their research on biological select agents and toxins. Officials froze research last Friday when they realized that there were problems with the system of accounting for high risk microbes and biological materials in the laboratories at Fort Detrick, MD and have begun an inventory of select agents and toxins at the facility. Not coincidentally, this is the same facility that has been under intense scrutiny after the FBI named researcher Bruce Ivins as their main suspect in the 2001 anthrax letter attacks.

“The decision was announced by institute commander, Col. John Skvorak, in a 4 February memo to employees. The memo, which ScienceInsider has obtained, says the standard of accountability that USAMRIID had been applying to its select agents and toxins was not in line with the standard required by the Army and the Department of Defense. USAMRIID officials believed that a satisfactory accounting involved finding all the items listed on its database, the Army and DOD wanted the converse; that is, all select agents and toxins needed to be matched to the database.”

The Army is clearly clamping down on their select agent research programs with very strict accounting of biological agents and, personnel in direct response to the Ivins case. Of note, on October 28, 2008 Army Regulation 50-1 came into effect. AR50-1, outlines a strict Biological Personnel Reliability Program for all DoD employees with access to BSAT. In order to be cleared to work with or have access to BSAT everyone must go through intense screening. This includes an interview, personnel security investigation, personnel records review, medical evaluation (includes mental evaluation and any medications) and drug testing.