Publications

The coronavirus disease 2019 (COVID-19) pandemic may have caught governments by surprise, but medical and public health communities have long warned of the potential for a high-consequence pandemic. Most recently, in September 2019, a report by the independent Global Preparedness Monitoring Board urged political leaders to take steps in their countries to improve preparedness for such events.1 One month later, the Global Health Security (GHS) Index, a framework for benchmarking health security in 195 countries, found that no country was fully prepared for a major health emergency.2 The Index identified serious weaknesses in many countries that could undermine their ability to respond to a pandemic, but it did not anticipate the poor response to the pandemic by high-scoring countries such as the US where major gaps in federal leadership resulted in a failure to mobilize the country’s substantial capacity.

We report key epidemiologic parameter estimates for coronavirus disease identified in peer-reviewed publications, preprint articles, and online reports. Range estimates for incubation period were 1.8–6.9 days, serial interval 4.0–7.5 days, and doubling time 2.3–7.4 days. The effective reproductive number varied widely, with reductions attributable to interventions. Case burden and infection fatality ratios increased with patient age. Implementation of combined interventions could reduce cases and delay epidemic peak up to 1 month. These parameters for transmission, disease severity, and intervention effectiveness are critical for guiding policy decisions. Estimates will likely change as new information becomes available.

In The Lancet, Denis Y Logunov and colleagues from the N F Gamaleya Research Institute of Epidemiology and Microbiology in Russia present findings from two phase 1/2, non-randomised, open-label studies of a heterologous, replication-deficient, recombinant adenovirus vector-based vaccine in both frozen and lyophilised formulations. The researchers enrolled 76 healthy adult volunteers (aged 18–60 years) into the two studies (38 people in each study); 53 (70%) participants were men and 23 (30%) were women. The primary outcome measures of the studies were safety and immunogenicity (antigen-specific humoral immunity). In phase 1 of each three-arm study, two groups of nine volunteers received one dose of either recombinant adenovirus type 26 (rAd26) vector or recombinant adenovirus type 5 (rAd5) vector, both carrying the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S), in lyophilised or frozen form. In phase 2, another group of 20 healthy adult volunteers in each study received sequential doses of rAd26-S followed by rAd5-S of one of the two formulations. Adverse events were mostly mild, with the most common adverse events being pain at injection site (44 [58%]), hyperthermia (38 [50%]), headache (32 [42%]), asthenia (21 [28%]), and muscle and joint pain (18 [24%]). Adverse events occurred at similar frequency for each vaccine vector, with each formulation, and after each dose. Serious adverse events did not arise in this small cohort. Both formulations of the vaccine were immunogenic in all participants, inducing neutralising humoral and cell-mediated responses. In phase 2, 85% of participants had detectable antibodies at 14 days after the priming dose, rising to 100% by day 21, with substantial titre rises after the boosting dose.

The world's attention has been drawn to the pace and progress of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) research, as scientists around the world race to better understand the virus and develop therapies and vaccines. While the fruits of this research cannot come soon enough, progress would not be possible were it not for profound advances in biotechnology in the past decade. The progress extends far beyond medical interventions and research tools, it also encompasses advances in agriculture, biological replacements for petroleum chemistry, and a myriad of novel biological products—from spider silk to laboratory grown meats to organic construction materials.^1-3 These myriad endeavors and innovations are part of the “bioeconomy,” which is defined as the economic activity that comes from bio-based feedstock (such as agricultural and forestry biomass), products or materials (like biofuels and chemicals), and processes that contribute sustainable solutions to resolving issues in areas such as food, energy, health, and the environment.^4,5,6 Strategies for developing and supporting national bioeconomies encompass diverse fields, including energy, agriculture, medicine, manufacturing, industrial chemistry, pharmaceuticals, and defense.

An important factor in growing the US bioeconomy is recruiting and training its future workforce. Other science, technology, engineering, and math (STEM) fields have relied on diverse educational opportunities for recruitment, including prestigious high school and collegiate competitions. For genetic engineering and synthetic biology, there are very few competitions; they include the Biodesign Competition and the much larger and scientifically focused International Genetically Engineered Machine (iGEM) competition. iGEM, run by an independent nonprofit organization, is often cited as a measure of progress in developing the synthetic biology workforce. Starting in 2021, iGEM will move its main competitive event, the “Giant Jamboree,” from its long-standing home in Boston to Paris, which is likely to negatively affect participation by the US team. In this article, we describe the value of iGEM to the bioeconomy and its upcoming challenges through a review of available literature, observation of the iGEM Jamboree, and interviews with 10 US-based iGEM team coaches. The coaches expressed positive views about the iGEM process for their students in providing a hands-on biotechnology experience, but they were concerned about the funding US students received to participate in iGEM compared with teams from other countries. They were also concerned that the relocation to Paris would negatively affect or preclude their participation. Possible options to continue the benefits of experiential learning in synthetic biology are discussed, including alternative funding for iGEM teams through a grant process and the need for additional biology competitions.

Since its first appearance in the United States in February 2020, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 3.77 million and killed over 140,000 people in the United States (as of July 20, 2020).¹ Responses to the virus, including closing venues where person-to-person spread was likely (eg, schools, churches, businesses) and requiring the use of masks and physical distancing measures when person-to-person contact could not be avoided, reduced the spread of SARS-CoV-2. At the same time, these protective actions have also radically transformed social life and upended national and household economies.^2,3 As the health crisis continues and pandemic fatigue starts to take hold, political leaders, health officials, and the general public are anxiously searching for solutions.

This report outlines a number of trends that are facilitating advances in different areas of the life sciences, including immunology, neuroscience, human genetics and reproductive science, agriculture and infectious disease. Research and development in these fields is overwhelmingly undertaken for peaceful purposes and potentially provides many benefits to society, the global economy, and future generations. However, the same areas of research raise a number of ethical, legal, safety and security concerns, including concerns that developments therein could feed into of new forms of biological weapons with different and potentially more damaging effects to those of the past.

The COVID-19 pandemic will continue for the foreseeable future, but widespread vaccination could hasten its end. At least 165 candidate vaccines for the SARS CoV-2 virus are in development around the world and there is hope that one or more of these candidates will soon be shown to be sufficiently safe and effective to achieve emergency use authorization in the United States. When a vaccine has been authorized for use, it will initially be in limited supply. During this period of scarcity, a plan is needed for how to allocate and distribute the limited supply—which groups should be prioritized to receive the vaccine first and which groups can wait until later. This difficult and potentially contentious topic is being actively discussed in the United States by the Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC) and the National Academy of Medicine (NAM), as well as globally at the World Health Organization (WHO) and elsewhere. The purpose of this report is to offer an additional ethics framework for use in making decisions about allocation of SARS-CoV-2 vaccine during this initial period of scarcity in the United States and make related suggestions about vaccine distribution. Our approach takes into account considerations of medical risk, public health, ethics and equity, economic impact, and logistics. We note where our approach aligns or differs from the 2018 CDC guidance for vaccine allocation in a severe influenza pandemic, which is the most recent pandemic vaccine guidance from the US government.

On 21 January, California took a major step to increase biosecurity in commercial gene synthesis, introducing legislation that requires all scientists purchasing gene synthesis products to use companies that perform screening on customers and the sequences they order. If enacted, this legislation would make it a competitive advantage for companies to take biosecurity seriously. Here, we argue that the US federal government and other governments should emulate California’s actions.

Enterotoxigenic E. coli (ETEC) and Shigella are enteropathogens causing significant global morbidity and mortality, particularly in low-income countries. No licensed vaccine exists for either pathogen, but candidates are in development, with the most advanced candidates potentially approaching pivotal efficacy testing within the next few years.

To curb the spread of disease and open the economy, the U.S. must implement a national strategy to increase testingof both symptomatic and asymptomatic people while ensuring timely test results. For people with COVID-19 symptoms and people in close contact with known cases, highly accurate laboratory diagnostic tests (“PCR” tests) are required, with results turned around in 24-48 hours to allow effective contact tracing. Better support is also needed for people who face difficulties in isolating if they test positive. For people without symptoms, we also need broad availability of more rapid but sometimes less accuratescreening tests (involving a number of test platforms including pooled PCR, "antigen" tests, and other point-of-care tests) to detect outbreaks sooner and give people more confidence in their workplaces and schools. This is particularly important for high-risk populations such as nursing homes, essential workplaces, and hard-hit communities that currently have limited resources for testing. Financial support for test recipients is needed because screening tests are generally not covered by insurance. Guidance from regulators and public health authorities will also be required on how to use these tests effectively. These tools are needed to control transmission and facilitate safer reopening of schools and workplaces.

Recent infectious disease outbreaks, including the ongoing global COVID-19 pandemic and Ebola in the Democratic Republic of the Congo, have demonstrated the critical importance of resilient health systems in safeguarding global health security. Importantly, the human, economic and political tolls of these crises are being amplified by health systems’ inabilities to respond quickly and effectively. Improving resilience within health systems can build on pre-existing strengths to enhance the readiness of health system actors to respond to crises, while also maintaining core functions. Using data gathered from a scoping literature review, interviews with key informants and from stakeholders who attended a workshop held in Dhaka, Bangladesh, we developed a Health System Resilience Checklist (‘the checklist’). The aim of the checklist is to measure the specific capacities, capabilities and processes that health systems need in order to ensure resilience in the face of both infectious disease outbreaks and natural hazards. The checklist is intended to be adapted and used in a broad set of countries as a component of ongoing processes to ensure that health actors, institutions and populations can mount an effective response to infectious disease outbreaks and natural hazards while also maintaining core healthcare services. The checklist is an important first step in improving health system resilience to these threats, but additional research and resources will be necessary to further refine and prioritise the checklist items and to pilot the checklist with the frontline health facilities that would be using it. This will help ensure its feasibility and durability for the long-term within the health systems strengthening and health security fields.

Community resilience is a community’s ability to maintain functioning (ie, delivery of services) during and after a disaster event. The Composite of Post-Event Well-Being (COPEWELL) is a system dynamics model of community resilience that predicts a community’s disaster-specific functioning over time. We explored COPEWELL’s usefulness as a practice-based tool for understanding community resilience and to engage partners in identifying resilience-strengthening strategies. In 2014, along with academic partners, the New York City Department of Health and Mental Hygiene organized an interdisciplinary work group that used COPEWELL to advance cross-sector engagement, design approaches to understand and strengthen community resilience, and identify local data to explore COPEWELL implementation at neighborhood levels. The authors conducted participant interviews and collected shared experiences to capture information on lessons learned. The COPEWELL model led to an improved understanding of community resilience among agency members and community partners. Integration and enhanced alignment of efforts among preparedness, disaster resilience, and community development emerged. The work group identified strategies to strengthen resilience. Searches of neighborhood-level data sets and mapping helped prioritize communities that are vulnerable to disasters (eg, medically vulnerable, socially isolated, low income). These actions increased understanding of available data, identified data gaps, and generated ideas for future data collection. The COPEWELL model can be used to drive an understanding of resilience, identify key geographic areas at risk during and after a disaster, spur efforts to build on local metrics, and result in innovative interventions that integrate and align efforts among emergency preparedness, community development, and broader public health initiatives.

The impact of the COVID-19 pandemic in the United States has been profound. Despite initial declines in cases in May 2020 following implementation of stringent stay-at-home orders, cases are resurging in most states. The number of deaths has been rising in many states, with hospitalization rates for COVID-19 now again matching or exceeding numbers seen at the peak in New York City in March and April. Hospitals are under pressure or approaching a crisis in many places around the country. This resurgence is stressing many sectors of society, from businesses to education to health care. Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset.

This brief report describes concrete policy actions at the federal, state, and local levels that are needed to get control of the COVID-19 pandemic in the United States.

The Johns Hopkins Center for Health Security, a World Health Organization (WHO) Collaborating Centre on Global Health Security, has worked with WHO on the development of various tools and technical guidance for mass gatherings in the context of COVID-19. The primary aim of this partnership is to encourage stakeholders to use a risk-informed decision-making process when planning for mass gatherings and, specifically, to identify and mitigate the risk of spreading COVID-19 during the mass gathering. This process includes conducting risk assessments to determine the overall risk of disease spread connected to a mass gathering.

In view of the current COVID-19 pandemic, WHO, with the support of the Center and other members of the Novel Coronavirus-19 Mass Gatherings Expert Group, has developed a series of risk assessment tools and other resources for generic as well as sports- and religious-specific mass gatherings. These risk assessment tools include a risk evaluation, mitigation, and communication strategy to aid host countries and organizers of mass gatherings in assessing the specific risk of COVID-19 to their event. A training course has also been created that provides a brief overview of mass gathering planning during COVID-19 and walks users through the use of the risk assessment tools.

Resources for mass gathering planning in the context of COVID-19 can be found at the following link after selecting “COVID-19: Mass Gatherings” from the drop down menu.

Mass Gathering Risk Assessment Tools

1. WHO Mass Gathering COVID-19 Risk Assessment Tool – Generic Events (revised July 10, 2020). Link / Excel Tool
2. WHO Mass Gathering COVID-19 Risk Assessment Tool – Sports Events (revised July 10, 2020). Link / Excel Tool
3. WHO Mass Gathering COVID-19 Risk Assessment Tool – Religious Events (revised July 10, 2020). Link / Excel Tool

This report considers human factors in relation to future vaccines against the novel coronavirus (SARS-CoV-2), drawing on insights from design thinking and the social, behavioral, and communication sciences. It provides recommendations—directed to both US policymakers and practitioners, as well as nontraditional partners new to public health’s mission of vaccination—on how to advance public understanding of, access to, and acceptance of vaccines that protect against COVID-19.

The Kivu Ebola epidemic began on August 1, 2018, when four cases were confirmed in North Kivu Province in eastern Democratic Republic of the Congo (DRC).¹ To date, the epidemic has led to over 3,400 confirmed and suspected cases in the DRC and over 2,200 deaths. Because there is frequent movement from North Kivu across the border into Uganda, including a regular influx of refugees, the Ugandan government and its partners put themselves on high alert and mobilized resources to prevent the importation of cases, detect imported disease quickly, contain the spread of imported disease, and treat sick people appropriately.

Exemplars in Global Health uses standardized methods to pinpoint countries that outperformed peers in key health outcomes, beyond what would be expected from their economic growth. Guided by global and in-country experts, we also consider geographic diversity, data availability, and research feasibility to select Exemplar candidates. We then conduct further research and analysis to validate our initial assessment. Learn more.

Before an infectious disease outbreak of any size can be addressed and before illness can be treated, it must be first be identified through the diagnosis of cases. Diagnostic testing is a mainstay of not only clinical medicine but also epidemiologic investigation. Limitations surrounding access to diagnostic testing have dominated much of the current response to COVID-19 and highlight the need to have more rapid, convenient, and equitable access to testing. Looking ahead, through the increasing diffusion of health technology to consumers and patients, it is becoming more feasible for diagnostic testing to be placed in the hands of the patient. Such tests when used to diagnose infectious disease, and coupled to information technology, could have a transformative benefit for future pandemic response.

The Johns Hopkins Center for Health Security conducted this study to develop an expert assessment of the promise and challenges posed by at home infectious diagnostic technologies. A major aim of this study is to inform pandemic preparedness activities that rely on diagnostic technologies and determine how at home approaches can integrate with and augment the existing diagnostic paradigm.

The lack of radiation knowledge among the general public continues to be a challenge for building communities prepared for radiological emergencies. This study applied a multi-criteria decision analysis (MCDA) to the results of an expert survey to identify priority risk reduction messages and challenges to increasing community radiological emergency preparedness.

This document describes the value of serosurveys (antibody studies) for SARS-CoV-2 infections, the different methods by which they can be performed, and the resources required to produce actionable information. It provides recommendations for the US government and states for performing these studies and deriving value from them.