Biosecurity
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Abstract:

Anxiety about threats from the microbial world and about the deliberate misuse of microorganisms has led to efforts to define and control these dangers using lists and regulations. One list with tremendous legal implications and a potentially huge impact on research is the Select Agents and Toxins List, which was created by the US Government to limit the possession of and access to particular microorganisms and toxins. In this article, in addition to highlighting general problems with taxonomy-based, microorganism-centric lists, we discuss our view that such lists may have the paradoxical effect of increasing the societal vulnerability to biological attack and natural epidemics by interfering with the sharing of microbial samples and hindering research on vaccines and therapeutics.

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Journal Articles
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Nature Reviews Microbiology
Authors
Arturo Casadevall
David Relman
David Relman
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BACKGROUND: The optimal community-level approach to control pandemic influenza is unknown. METHODS: We estimated the health outcomes and costs of combinations of 4 social distancing strategies and 2 antiviral medication strategies to mitigate an influenza pandemic for a demographically typical US community. We used a social network, agent-based model to estimate strategy effectiveness and an economic model to estimate health resource use and costs. We used data from the literature to estimate clinical outcomes and health care utilization. RESULTS: At 1% influenza mortality, moderate infectivity (R(o) of 2.1 or greater), and 60% population compliance, the preferred strategy is adult and child social distancing, school closure, and antiviral treatment and prophylaxis. This strategy reduces the prevalence of cases in the population from 35% to 10%, averts 2480 cases per 10,000 population, costs $2700 per case averted, and costs $31,300 per quality-adjusted life-year gained, compared with the same strategy without school closure. The addition of school closure to adult and child social distancing and antiviral treatment and prophylaxis, if available, is not cost-effective for viral strains with low infectivity (R(o) of 1.6 and below) and low case fatality rates (below 1%). High population compliance lowers costs to society substantially when the pandemic strain is severe (R(o) of 2.1 or greater). CONCLUSIONS: Multilayered mitigation strategies that include adult and child social distancing, use of antivirals, and school closure are cost-effective for a moderate to severe pandemic. Choice of strategy should be driven by the severity of the pandemic, as defined by the case fatality rate and infectivity.

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Journal Articles
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Clinical Infectious Diseases
Authors
Daniella Perlroth
Glass RJ
Davey VJ
Cannon D
Alan M. Garber
Douglas K. Owens
Douglas K. Owens
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Since the 2001 anthrax attacks, members of the biosecurity community and US government officials have expressed a growing sense of alarm at the threat of a biological attack.  The Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism recently predicted that a terrorist attack involving WMD is likely to take place by 2013 and identified biological terrorism as the most likely contingency.  To counter this threat, increasing emphasis has been placed on the role of microbial forensics in deterring an attack. New infrastructure has been established by the US government to develop capabilities to identify the source of a pathogen used in an attack and identify the perpetrators. However, many open questions remain about the potential efficacy of this approach both from a technological capabilities standpoint and from a deterrence perspective.

Existing technologies can be borrowed from molecular biology to identify elements in a pathogen's DNA, which could help investigators trace it back to a specific source strain. However, these tools are limited, and new methods should be developed to increase confidence in microbial forensics analyses. Moreover, a comprehensive genome database of pathogen strains is necessary for an effective investigation in the event of an attack. Who will cover the costs of sequencing pathogen genome strains to generate such a database? Will there be obstacles to gaining cooperation from academic and government facilities within the United States and internationally?  In the best-case scenario, advances in microbial forensics could enable us to identify the source of a biological attack; would these capabilities effectively deter non-state actors? These questions must be addressed to determine the extent to which microbial forensics programs can meet their stated goals.

Jaime Yassif is a doctoral candidate in the Biophysics Group at UC Berkeley. She is conducting her thesis research in the Liphardt lab, where she studies the dynamics of RNA-binding proteins using a single-molecule technique called plasmon rulers.

Prior to her graduate work, Ms. Yassif worked for several years in science and security policy and arms control.  She began as a research assistant at the Federation of American Scientists, where she contributed to the writing of Senate Foreign Relations Committee testimony on radiological weapons and authored a piece on radiological decontamination in Defense News. She then worked as a program officer at the Nuclear Threat Initiative, where she provided support for the organization's four key program areas-Russia/New Independent States, Biological, Regional and Communications-and managed the organization of an international workshop on Global Best Practices in Nuclear Materials Management. This was followed by a fellowship to study the Chinese nuclear posture at Tsinghua University in Beijing.

Ms. Yassif holds an MA in Science and Security from the War Studies Department at King's College London, where she wrote her thesis on verification of the Biological Weapons Convention.  She received her bachelor's degree in Biology from Swarthmore College. Ms. Yassif is former president of the student-run Science, Technology and Engineering Policy group at UC Berkeley and a member of Women in International Security.

Martha Crenshaw is a senior fellow at the Center for International Security and Cooperation and the Freeman Spogli Institute, and professor of political science (by courtesy). Her current research focuses on why the United States is the target of terrorism, the effectiveness of counter terrorism policies, and mapping terrorist organizations. Professor Crenshaw served on the Executive Board of Women in International Security and chaired the American Political Science Association (APSA) Task Force on Political Violence and Terrorism. She was a Guggenheim Fellow in 2005-2006. Her edited book, The Consequences of Counterterrorism in Democracies, is being published by the Russell Sage Foundation.

Reuben W. Hills Conference Room

Jaime Yassif PhD candidate, UC Berkeley Biophysics Graduate Group Speaker
Martha Crenshaw Professor of Political Science (by courtesy) and Senior Fellow at CISAC and FSI Commentator
Seminars
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Abstract
One of the biggest themes of the 21st century is interconnection -- specifically, the interconnection of people and data.  These interconnections can change everything about how we see the world, how the world sees us, and how we work together.  Where some people might see "big brother," I see empowerment -- empowerment of groups and individuals to improve quality of life and reduce our impact on the planet. 

Megan Smith oversees teams that manage early-stage partnerships, explorations and technology licensing. She also leads the Google.org team, guiding strategy and developing new partnerships and internal projects with Google's engineering and product teams. She joined Google in 2003 and has led several of the company's acquisitions, including Keyhole (Google Earth), Where2Tech (Google Maps), and Picasa. She also co-led the company's early work with publishers for Google Book Search. Previously, Megan was the CEO and, earlier, COO of PlanetOut, the leading gay, lesbian, bisexual and transgender online community. Under her leadership, PlanetOut grew tenfold in reach and revenue. Prior to that, Megan was at General Magic for six years working on handheld communications products and partnerships. She also worked in multimedia at Apple Japan in Tokyo.

Over the years, Megan has contributed to a wide range of engineering projects, such as designing an award-winning bicycle lock; working on a space station construction research project that eventually flew on the U.S. space shuttle; and running a field-research study on solar cookstoves in South America. She was also a member of the MIT-Solectria student team that designed, built, and raced a solar car in the first cross-continental solar car race, covering 2000 miles of the Australian outback. She was selected as one of the 100 World Economic Forum technology pioneers for 2001 and 2002.

Megan holds a bachelor's degree and a master's degree in mechanical engineering from MIT, where she now serves on the board. She completed her master's thesis work at the MIT Media Lab.

Summary of the Seminar
Megan Smith, Vice President, New Business Development and General Manager, Google.org., argued that greater interconnectedness achieved by information technology is a major liberating force in the world. Whether it is aiding the coordination of protests or increasing transparency of governments, the exchange of information has huge benefits. This is not a new phenomenon. In places where people have been able to exchange information easily, social progress has followed. Megan cited the example of Seneca Falls, New York where the canal system allowed for extensive communication; it became significant in both the women's rights and abolition movements.

While a large proportion of the world is benefiting from greater interconnectedness, Africa still lacks the infrastructure to take full advantage. Submarine fiber optic cables are necessary for quick and cheap internet cables and many African countries, particularly in the east, are not connected to these, relying instead on satellites. This is likely to change over the next few years, bringing great potential for further development.

The mission of Google.org is to use technology to drive solutions to global challenges such as climate change, pandemic disease and poverty. The organization was set up as part of a commitment to devote approximately one percent of Google's equity plus one percent of annual profits to philanthropy, along with employee time.  Google.org now places its strategic focus on those projects that can leverage the resources of Google staff, particularly its engineers.

Current projects that harness the power of information include:

  • Google Flu Trends: This uses aggregated Google search data to estimate flu activity up to two weeks earlier than traditional methods. This system has almost 90% accuracy in real time flu prediction and is therefore an extremely useful tool for health delivery agencies. It is now being used in 30 countries. Google is also starting to work in Cambodia to collect data around SARS.
  • Google Power Meter provides a system for consumers to understand their in-home energy use and to take steps to reducing this. The Meter receives information from utility smart meters and in-home energy management devices and visualizes this information on iGoogle (a personalized Google homepage).The premise underlying this project is that greater information is going to be crucial to tackling climate change and consumers ought to be able to be empowered to make informed decisions about their energy use.
  • Disaster relief: In response to the Haitian earthquake, a team of engineers worked with the U.S. Department of State to create an online People Finder gadget so that people can submit information about missing persons and to search the database. Google Earth satellite images have also been used to document the extent of damage.

Wallenberg Theater

Megan Smith Vice President, New Business Development, and General Manager Speaker Google.org
Seminars
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The world of genomics is transforming medicine, and is likely to influence the future development of new drugs, diagnostics, and vaccines. To date, the greater focus of genomics and medicine has been on conditions affecting resourcewealthy settings, primarily involving scientists and companies in those settings. However, we believe that it is possible to expand genomics into a more global technology that can also focus on diseases of resource-limited settings. This goal can be achieved if genomics is made a global priority. We feel one way to move in this direction is through a comprehensive approach to infectious diseases-i.e., an Infectious Disease Genomics Project-that would mirror the Human Genome Project. Without an active, unified effort specifically focused on allowing actors at any level to participate in the genomics revolution, infectious diseases that primarily affect the poor will likely not achieve the same level of scientifici advancement as diseases affecting the wealthy.

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Journal Articles
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Public Library of Science – Biology
Authors
Rajesh Gupta
Mark H. Michalski
Frank R. Rijsberman
Authors
Karen Eggleston
Karen Eggleston
News Type
News
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In December 2009, the Asia Health Policy Program celebrates the first anniversary of the launch of the AHPP working paper series on health and demographic change in the Asia-Pacific. The series showcases research by AHPP’s own affiliated faculty, postdoctoral fellows, and visiting scholars, as well as selected works by other scholars from the region.

To date AHPP has released eleven research papers in the series, by authors from China, South Korea, Thailand, Taiwan, Pakistan, and the US, with more on the way from Japan and Vietnam. Topics range from “The Effect of Informal Caregiving on Labor Market Outcomes in South Korea” and “Comparing Public and Private Hospitals in China,” to “Pandemic Influenza and the Globalization of Public Health.”  The working papers are available at the Asia Health Policy website.

AHPP considers quality research papers from leading research universities and think tanks across the Asia-Pacific region for inclusion in the working paper series. If interested, please contact Karen Eggleston.

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Background: Decisions on the timing and extent of vaccination against pandemic (H1N1) 2009 virus are complex.

Objective: To estimate the effectiveness and cost-effectiveness of pandemic influenza (H1N1) vaccination under different scenarios in October or November 2009.

Design: Compartmental epidemic model in conjunction with a Markov model of disease progression.

Data Sources: Literature and expert opinion.

Target Population: Residents of a major U.S. metropolitan city with a population of 8.3 million.

Time Horizon: Lifetime.

Perspective: Societal.

Interventions: Vaccination in mid-October or mid-November 2009.

Outcome Measures: Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.

Results of Base-Case Analysis: Assuming each primary infection causes 1.5 secondary infections, vaccinating 40% of the population in October or November would be cost-saving. Vaccination in October would avert 2051 deaths, gain 69 679 QALYs, and save $469 million compared with no vaccination; vaccination in November would avert 1468 deaths, gain 49 422 QALYs, and save $302 million.

Results of Sensitivity Analysis: Vaccination is even more cost-saving if longer incubation periods, lower rates of infectiousness, or increased implementation of nonpharmaceutical interventions delay time to the peak of the pandemic. Vaccination saves fewer lives and is less cost-effective if the epidemic peaks earlier than mid-October.

Limitations: The model assumed homogenous mixing of case-patients and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. Additional costs and savings not included in the model would make vaccination more cost-saving.

Conclusion: Earlier vaccination against pandemic (H1N1) 2009 prevents more deaths and is more cost-saving. Complete population coverage is not necessary to reduce the viral reproductive rate sufficiently to help shorten the pandemic.

Primary Funding Source: Agency for Healthcare Research and Quality and National Institute on Drug Abuse.

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Publication Type
Journal Articles
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Journal Publisher
Annals of Internal Medicine
Authors
Nayer Khazeni
Hutton DW
Alan M. Garber
Hupert N
Douglas K. Owens
Douglas Owens
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Background: The pandemic potential of influenza A (H5N1) virus is a prominent public health concern of the 21st century.

Objective: To estimate the effectiveness and cost-effectiveness of alternative pandemic (H5N1) mitigation and response strategies.

Design: Compartmental epidemic model in conjunction with a Markov model of disease progression.

Data Sources: Literature and expert opinion.

Target Population: Residents of a U.S. metropolitan city with a population of 8.3 million.

Time Horizon: Lifetime.

Perspective: Societal.

Interventions: 3 scenarios: 1) vaccination and antiviral pharmacotherapy in quantities similar to those currently available in the U.S. stockpile (stockpiled strategy), 2) stockpiled strategy but with expanded distribution of antiviral agents (expanded prophylaxis strategy), and 3) stockpiled strategy but with adjuvanted vaccine (expanded vaccination strategy). All scenarios assumed standard nonpharmaceutical interventions.

Outcome Measures: Infections and deaths averted, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness.

Results of Base-Case Analysis: Expanded vaccination was the most effective and cost-effective of the 3 strategies, averting 68% of infections and deaths and gaining 404 030 QALYs at $10 844 per QALY gained relative to the stockpiled strategy.

Results of Sensitivity Analysis: Expanded vaccination remained incrementally cost-effective over a wide range of assumptions.

Limitations: The model assumed homogenous mixing of cases and contacts; heterogeneous mixing would result in faster initial spread, followed by slower spread. We did not model interventions for children or older adults; the model is not designed to target interventions to specific groups.

Conclusion: Expanded adjuvanted vaccination is an effective and cost-effective mitigation strategy for an influenza A (H5N1) pandemic. Expanded antiviral prophylaxis can help delay the pandemic while additional strategies are implemented.

Primary Funding Source: National Institutes of Health and Agency for Healthcare Research and Quality.

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1
Publication Type
Journal Articles
Publication Date
Journal Publisher
Annals of Internal Medicine
Authors
Nayer Khazeni
Hutton DW
Alan M. Garber
Douglas K. Owens
Douglas Owens
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