Global study finds there are big gaps in preparedness for epidemics and pandemics

via Nuclear Threat Initiative

EVEN HIGH-INCOME COUNTRIES ARE FOUND LACKING AND SCORE ONLY IN THE AVERAGE RANGE OF PREPAREDNESS

A new Global Health Security Index released today, the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries, suggests that not a single country in the world is fully prepared to handle an epidemic or pandemic. The GHS Index is a joint project of the Johns Hopkins Center for Health Security and the Nuclear Threat Initiative (NTI), with research by The Economist Intelligence Unit (EIU). The Center for Health Security is a part of the Johns Hopkins Bloomberg School of Public Health.

The inaugural GHS Index finds severe weaknesses in countries’ abilities to prevent, detect, and respond to significant disease outbreaks. The average overall 2019 GHS Index score is slightly over 40 out of a possible score of 100. Among the 60 highest-income countries assessed, the average score is 51.9.

Jennifer Nuzzo, associate professor at the Bloomberg School and senior scholar at the Center for Health Security, said the GHS Index, developed with guidance from an International Panel of Experts from 13 countries, can be used by health ministers and international organizations, philanthropists and funders, academics and researchers.

“The GHS Index finds that no country is fully prepared for naturally occurring, intentional, or accidental infectious disease outbreaks,” Nuzzo said. “Knowing that there is work to do, countries can use the index to identify gaps, build preparedness and best practices, and track progress over time.”

“Whether they be natural, accidental, or deliberate, infectious disease outbreaks can cause significant harm to health, peace, and prosperity if countries are not adequately prepared,” said Center for Health Security director Tom Inglesby. “It is important for national leaders to understand the risks that infectious diseases pose and commit to making improvements in preparedness for these events.”

The GHS Index assessed countries across six categories, 34 indicators, and 140 questions, using only open-source information and data from international organizations, including the World Health Organization, the World Organisation for Animal Health, the Food and Agriculture Organization of the United Nations (UN), and the World Bank.

Top findings

The Index found that:

  • Fewer than 7 percent of countries score in the highest tier in the category assessing the prevention of the emergence or release of pathogens.
  • Only 19 percent of countries receive top marks (scoring a 66.7 out of 100 or higher) in the category assessing early detection and reporting of epidemics of potential international concern.
  • Fewer than 5 percent of countries score in the highest tier in rapid response to and mitigation of spread of an epidemic.
  • With an average score of 26.4 out of 100, having a sufficient and robust health sector to treat the sick and protect health workers was the lowest-scoring category.

The GHS Index findings and recommendations for addressing significant gaps in global health security come amid an ongoing Ebola outbreak in the Democratic Republic of Congo and five years after the UN Security Council met in crisis over the Ebola epidemic in West Africa.

At a time when risks are magnified by a rapidly changing and interconnected world and rapid technology advances make it easier to create and engineer pathogens, knowing the risks is clearly not enough. Political will is needed to protect people from the consequence of epidemics, to take action to save lives, and to build a safer and more secure world.

Top recommendations

A core principle of the GHS Index is that health security is a collective responsibility. The GHS Index offers 33 recommendations for individual countries and for the international community. Recommendations include:

  • The UN Secretary-General should call a heads-of-state-level summit by 2021 on biological threats, including a focus on financing and emergency response.
  • National governments should commit to take action to address health security risks.
  • Health security capacity in every country should be transparent and regularly measured, and results should be published at least once every two years.
  • Leaders should improve coordination in insecure environments, especially linkages between security and public health authorities.
  • New financing mechanisms should be established to fill preparedness gaps, such as a new multilateral global health security matching fund and expansion of World Bank International Development Association allocations to include preparedness.
  • The UN Secretary-General should designate a permanent facilitator or unit for high-consequence biological events.
  • Countries should test their health security capacities and publish after-action reviews, at least annually.
  • Governments and donors should take into account countries’ political and security risk factors when supporting health security capacity development.

The GHS Index was developed over two and a half years. Key steps included an initial pilot project to test the framework; reviews by the International Panel of Experts that includes 21 experts from 13 countries; a yearlong data collection and validation process by 110 EIU researchers and reviews throughout the world; and opportunities for governments to validate data.

Learn more: Inaugural Global Health Security Index Finds Significant Gaps in Preparedness for Epidemics and Pandemics

 

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Combating epidemics with powerful new synthetic vaccines

ADDomer: Synthetic multiepitope display scaffold for next generation vaccines. We developed ADDomer, a next generation synthetic vaccine that mimics features of Chikungunya virus, to efficiently prime the immune system to protect against this pathogen via University of Bristol

A new type of vaccine that can be stored at warmer temperatures, removing the need for refrigeration, has been developed for mosquito-borne virus Chikungunya in a major advance in vaccine technology.

The findings, published in Science Advances today [Wednesday 25 September], reveal exceptionally promising results for the Chikungunya vaccine candidate, which has been engineered using a synthetic protein scaffold that could revolutionise the way vaccines are designed, produced and stored.

Infectious diseases continue to plague populations worldwide. Among the means at our disposal to counter this threat, vaccination has proven to be exceptionally powerful. Smallpox has been eradicated, measles, polio and tetanus constrained from the world by vaccination. However, severe challenges to human health persist, evidenced by epidemics caused by Ebola, Zika and others. This is particularly severe in developing countries which often lack adequate infrastructure and resources to prevent or manage outbreaks, bringing about disruption and damage in affected communities and massive economic shortfall.

A recent example is Chikungunya, a virus transmitted by the bite of an infected mosquito. The disease causes crippling headache, vomiting, swelling of limbs and can lead to death. Even if a fever ends abruptly, chronic symptoms such as intense joint pain, insomnia and extreme prostration remain. Formerly confined to sub-Saharan Africa, Chikungunya has recently spread worldwide as its mosquito host leaves its natural habitat due to deforestation and climate change, with recent outbreaks in USA and Europe causing alarm.

Researchers from the University of Bristol and the French National Centre for Scientific Research (CNRS) in Grenoble, France, teamed up with computer technology giant Oracle to find a way to make vaccines that are thermostable (able to withstand warm temperatures), can be designed quickly and are easily produced.

“We were working with a protein that forms a multimeric particle resembling a virus but is completely safe, because it has no genetic material inside, said Pascal Fender, expert virologist at CNRS. “Completely by chance, we discovered that this particle was incredibly stable even after months, without refrigeration.”

“This particle has a very flexible, exposed surface that can be easily engineered, added Imre Berger, Director of the Max Planck-Bristol Centre for Minimal Biology in Bristol. “We figured that we could insert small, harmless bits of Chikungunya to generate a virus-like mimic we could potentially use as a vaccine.”

To validate their design, the scientists employed cryo-electron microscopy, a powerful new technique recently installed in Bristol’s state-of-the-art microscopy facility headed by Christiane Schaffitzel, co-author of the study. Cryo-EM yields very large data sets from which the structure of a sample can be determined at near atomic resolution, requiring massive parallel computing.

Enabled by Oracle’s high-performance cloud infrastructure, the team developed a novel computational approach to create an accurate digital model of the synthetic vaccine. University of Bristol IT specialists Christopher Woods and Matt Williams, together with colleagues at Oracle, implemented software packages seamlessly on the cloud in this pioneering effort. Christopher explained: “We were able to process the large data sets obtained by the microscope on the cloud in a fraction of the time and at much lower cost than previously thought possible.”

“Researchers have had a long tradition of building and installing their own super computers on-premises, but cloud computing is allowing them to run large data sets in record time, with fast connectivity and low latency. This is helping them crunch data and make scientific breakthroughs much faster. Going forward, technologies like machine learning and cloud computing will play a significant part in the scientific world, and we are delighted we could help the researchers with this important discovery,” added Phil Bates, leading cloud architect at Oracle.

The particles the scientists designed yielded exceptionally promising results in animal studies, soundly setting the stage for a future vaccine to combat Chikungunya disease.

“We were thoroughly delighted,” continued Imre Berger. “Viruses are waiting to strike, and we need to have the tools ready to tackle this global threat. Our vaccine candidate is easy to manufacture, extremely stable and elicits a powerful immune response. It can be stored and transported without refrigeration to countries and patients where it is most needed. Intriguingly, we can now rapidly engineer similar vaccines to combat many other infectious diseases just as well.”

“It really ticks a lot of boxes,” concluded Fred Garzoni, founder of Imophoron Ltd, a Bristol biotech start-up developing new vaccines derived from the present work. “Many challenges in the industry require innovative solutions, to bring powerful new vaccines to patients. Matching cutting-edge synthetic biology with cloud computing turned out to be a winner.”

Learn more: Powerful new synthetic vaccines to combat epidemics

 

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Outbreaks of enterovirus could be predicted up to two years before they may occur

An illustration of an Enterovirus

Scientists have identified the cause of outbreaks of enterovirus, one of the most prevalent types of virus in the world.

The findings, from researchers at Imperial College London and published in the journal Science, may help the public and healthcare workers prepare for an outbreak up to two years before it occurs.

We now understand why these outbreaks occur, and that they are actually highly predictable

Dr Margarita Pons-SalortStudy author

The work, funded by the Wellcome Trust, has shown for the first time that the frequency of enterovirus outbreaks over time are linked to birth rates.

Enteroviruses infect mostly children under 10 years old, and strike millions of youngsters every year – 50 million in the U.S. alone.

There are over 100 different types of enterovirus that infect people, causing a range of illnesses, from mild cold-like symptoms such as coughs, sore throat and fever, to more serious conditions such as hand-foot-and-mouth disease, viral meningitis, and encephalitis.

Infections tend to peak during summer and autumn months. Although there are no specific treatments, there is one vaccine available, and others in development.

Finding clues

There have been a number of serious enterovirus outbreaks in recent years. In 2014 a particular strain in the U.S. was linked to severe respiratory illness in young children, and there are thought to be over one million cases of hand-foot-and-mouth disease in China each year.

But despite the viruses causing so many infections, scientists still don’t fully understand what causes outbreaks.

Dr Margarita Pons-Salort, co-author of the research from the School of Public Health at Imperial said: “There are many different types of enteroviruses that infect humans. Some cause epidemics every year, while others cause epidemics every two or three years. However, until now we didn’t know what determined the frequency of these outbreaks, or why some viruses seemed to cause large outbreaks in certain years.”

via Imperial College London

Birth rate link

In the study, the team found that outbreaks of a given type of enterovirus were largely determined by the number of children born each year and the development of long-lasting immunity against that type following infection.

Once a child is infected with a specific type of enterovirus, they usually develop immunity to further infections with that virus. The team found that after each outbreak there is a time lag – from the end of the initial outbreak to a new pool of children being born who have not encountered the virus. This second group of children then become infected, and a subsequent outbreak occurs.

The team used a mathematical model to simulate these epidemic patterns for each of the 20 most common types of enterovirus.

To build the model, they used Japanese enterovirus surveillance data. Japan keeps incredibly detailed information on enterovirus outbreaks, and the team used 14 years’ worth of information to build the model (from 2000-2014).

Preparing for an outbreak

They then tested the model, and found that it was able to predict subsequent outbreaks in 2015 and 2016 for most types of enterovirus.

“The accuracy of our model to explain the data means we now understand why these outbreaks occur, and that they are actually highly predictable” said Dr Pons-Salort.

She continued: “This information could allow medical staff to prepare ahead of the outbreak. Our model will also help design vaccination strategies (i.e. who should be vaccinated and when), and anticipate the impact of the vaccine. For instance, it will allow us to calculate the proportion of children that should be vaccinated to avoid a new outbreak.”

The team are now testing their model on data from other countries, to ensure it can be applied to other regions around the world.

Their work also suggested that certain types of enteroviruses can fundamentally change their ‘appearance’ and become more virulent, or more transmissible between people. The team are now working on methods to understand these changes.

Learn more: Viral outbreaks could be predicted two years in advance by mathematical model

 

 

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Epidemics and artificial intelligence

via storify.com

via storify.com

AI may predict which animal species carry diseases dangerous to people

BETWEEN 1346 and 1353 the Black Death killed over a third of Europe’s population. It took 150 years for the continent to recover. The disease was so devastating that it changed the social order, as a scarcity of labour led to higher wages for the survivors, hastening the demise of feudalism.

The plague was caused by Yersinia pestis, a bacterium that lives in fleas. In Europe, those fleas lived mostly on black rats (pictured). In Asia, where the disease came from, they lived on gerbils. It was thus a zoonotic illness: one usually carried by animals, but which infects people when given the chance. Since human beings have little evolutionary experience with such illnesses, and therefore little resistance to them, they can be particularly dangerous. Ebola fever is a zoonosis. So, as their names suggest, are the swine- and bird-flu strains that keep epidemiologists awake at night.

Trying to work out which animals are reservoirs of disease that might infect humans is therefore an important job. It is also a tricky one. There are lots of animal species, a lot of unpleasant viruses and bacteria, and not enough zoologists and doctors to sort through them all. But Barbara Han of the Cary Institute of Ecosystem Studies, in New York, and her colleagues think they have a way to help with this labour shortage. They propose to apply artificial intelligence (AI) to the problem.

As they describe in a paper in the Proceedings of the National Academy of Sciences, they have used a form of AI called machine learning in the search for reservoir species. Machine learning lets computers study large sets of data and identify patterns and organising principles. It is a hot topic among the world’s big technology firms, such as Google and Amazon, who have plenty of data to make sense of. Dr Han and her colleagues set their computers the task of looking at rodents, and searching for rules that describe which ones are likely to harbour and transmit potentially zoonotic diseases.

Zoologists recognise more than 2,200 species of rodent. Of these, 217 are known reservoirs of pathogens (ranging from viruses and bacteria to protozoa and worms) that have an appetite for humans. At least 79 carry more than one such pathogen.

Read more: Epidemics and artificial intelligence

 

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