Health Security最新文献

In this article, we propose a metagenomic next-generation sequencing (mNGS) system for symptomatic clinical respiratory disease samples in Israel to enable detection early enough to contain novel pathogen outbreaks, limit international spread and expedite countermeasure development. We built an open-source, interactive SEIR (susceptible, exposed, infectious, recovered)-based model extending the work of Sharma et al (2023) for 7 representative known respiratory pathogens with pandemic potential, aiming to estimate costs and detection time for the identification of a novel respiratory pathogen in Israel through a network of mNGS monitoring in hospitals. We find that a novel pathogen with SARS-CoV-2-like characteristics could be detected within 68 days (interquartile range [IQR]: 53 to 80) after the first 2 emergency department presentations and 213 (IQR: 94 to 429) total infections across Israel. This surveillance system would cost US$24 million annually over 10 years when implemented in Israel's 6 largest hospitals, covering 37% of the population. Our open-source interactive model allows policymakers and experts to explore different system configurations and their associated tradeoffs between cost, detection speed, and population coverage.

Warnings of pathogens manufactured to target a specific ethnic group, so-called genetic bioweapons, have recently received considerable media attention. Genetic bioweapons figure prominently in reports on potential future risks emerging from combining genetic research, artificial intelligence and synthetic biology. They are also part of political narratives signaling imminent danger because of ongoing weapons development. However, little is known about the feasibility of genetically targeted weapons from the vantage point of natural genetic variation. To validate the fact base behind the narrative of genetic bioweapons, we analyzed the distribution across ethnic groups of 149 well-validated genetic variants with a role in modulating infection. We found only 3 variants that could be used as a basis for ethnic targeting with high specificity, all associated with indolent, treatable infections. In contrast, analysis of 136 variants modulating human response to pharmaceutical agents yielded 6 variants, all associated severe drug side effects in certain ethnicities, while others remained unaffected. We concluded that genetic weapons in the form of targeted pathogens have received unwarranted attention, while misuse of prescription drugs for ethnic targeting is a more imminent risk.

Strengthening biosecurity is critical for preventing the misuse of life sciences and achieving the goals of the Biological Weapons Convention (BWC). However, the global biosecurity landscape is hindered by fragmented efforts, inconsistent regulations, and limited resources, particularly in low- and middle-income countries and regions. Addressing biosecurity challenges requires active engagement of diverse stakeholders, including government, international organizations, academia, professional associations, industry, and civil society organizations. All of these stakeholders play key and complementary roles in different aspects of biosecurity. In this article, we examine 4 case studies for multistakeholder engagements and analyze major stakeholders for their relevant biosecurity roles, strengths, and limitations. We also provide policy recommendations and practical steps to fully realize the potential of multistakeholder engagement, including building networks and coalitions of stakeholders, creating educational and training initiatives, advocating for biosecurity standards, and improving communication channels that are suited to the interests of stakeholders. Additionally, we highlight the importance of having an inclusive and diverse representation of stakeholders. Multistakeholder engagement could enhance biosecurity and lower global risks while building robust structures to successfully handle biological threats in the future by promoting synergies while maximizing the optimal use of available resources.

When outbreaks of emerging and reemerging zoonotic diseases are discussed, little attention is paid to differential gender impacts, or to gender involvement and roles in different settings during the outbreak. Gender roles shape how individuals' interactions with animals, wildlife, other people and the environment, which influences exposure to zoonotic pathogens. For example, in some rural communities, men may face risks of exposure to emerging pathogens during hunting whilst women who primarily take care of domestic animals may face prolonged exposure to other zoonotic diseases. In some settings, women (and men) lack access to health protection, education or communication with health officials (medical doctors or veterinarians). In some cultures, women are not allowed to speak directly with male service providers, further limiting their access to critical information and services. One Health is a holistic, inclusive approach which should be incorporating a gender lens when considering zoonoses. This includes thinking about the need to create appropriate gender sensitive policies that address disparities in surveillance, response, prevention, detection, and control of the disease (or health issue) being addressed. In this paper, we highlight these issues through several case studies that demonstrate the importance of including gender in zoonotic disease response and, ideally, when implementing prevention measures.

One of the key points of agreement emerging from the contentious scientific and public debate about oversight of dual use research of concern (DURC) in the biological sciences is the importance of transparency for promoting public trust and accountability. Transparency is one of the pillars of President Trump's executive order "Improving the Safety and Security of Biological Research" and the National Institutes of Health's new policy concerning the operation of institutional biosafety committees. Although previous federal policies have also emphasized transparency, it has become abundantly clear to many commentators, biosafety activists, and government leaders that these policies did not go far enough, and that enhancing transparency is essential for ensuring ethical oversight of DURC. In this commentary, I advocate for transparency with respect to journal review of DURC research.

In infectious disease surveillance, laboratory-confirmed case counts and test positivity (proportion of tests positive for the target pathogen) are commonly used to monitor disease activity. However, these test-based data are affected not only by disease incidence but also by testing intensity, often making interpretations difficult. To help address this challenge, we present a generalizable, systematic framework that considers the number of tests performed, number of test-positive counts, and test positivity. With explicit consideration of ascertainment bias, we explain why all 3 indicators should be used to improve data interpretation, situational assessment, and communication.

Burkholderia pseudomallei, the causative agent of melioidosis, poses significant risks to human and animal health as an environmental pathogen with potential for misuse as a biological agent. With a recent case in the continental United States and associated positive environmental samples, there is an increasing need for a more thorough environmental surveillance program to determine the potential scope of environmental B pseudomallei in the continental United States. Such a biosurveillance program would be most efficient-in terms of cost, scope, and impact-when approached through the One Health framework, integrating animal and environmental biosurveillance to inform occupational, public, and veterinary health practitioners. Feral swine may serve as a valuable sentinel species due to their extensive rooting behavior in soil and widespread, invasive presence in the southern United States. Increasing their utility for B pseudomallei surveillance is preestablished federal and state management programs that include animal removal from the environment and pathogen testing. Other environmental sampling methods, such as surface water and wastewater surveillance, could provide sampling coverage of large geographic areas with relatively few samples and associated costs. The environmental detection of B pseudomallei in Mississippi underscores the need for broader biosurveillance efforts to inform the relative risk assumptions used by human and animal health practitioners to promptly diagnose patients. A comprehensive One Health strategy is essential for accurately mapping the distribution of B pseudomallei and ensuring effective risk management.

Risk assessments for emerging infectious disease threats are often conducted independently of affected communities. Participatory approaches to risk assessment present an opportunity to integrate community knowledge early in the risk-based decisionmaking process. We conducted a scoping review to understand the breadth of evidence from human, animal, and environmental health disciplines for integrating community participation in steps of the risk assessment process. A systematic literature search in PubMed, Scopus, Ei Compendex, Embase, Web of Science, and Global Health Database identified 4993 articles, of which 138 met inclusion criteria for the review. The types of participatory approaches described in the risk assessment literature varied by degree of community involvement, types of communities engaged, and activities implemented to engage communities. There was substantial evidence from environmental contamination and climate change studies on conducting hazard and exposure assessments within a community-based participatory research model. However, examples of community participation in problem formulation, capacity assessments, data report-back, and pathway mapping were limited. Additionally, the limited examples of community-initiated and community-driven risk assessments suggest a need for improving community involvement from the earliest stages of research priority setting through all phases of data collection, analysis, and interpretation. Further research is also needed on adapting participatory approaches for emerging infectious disease risk assessments.

Diseases caused by pathogens that affect animals, humans, and their shared environment (zoonoses) impact regional and global health security. Context-specific recommendations could help control animal-to-human pathogen spillover and mitigate the risk of epidemics and pandemics. Our objective is to share the codevelopment of a guidebook to counter zoonotic spillover in Southeast Asia and how participatory approaches and implementation science guided One Health actor groups towards a common goal. The project was a collaboration between the International Network for Governmental Science Advice Asia and the US National Academies of Sciences, Engineering, and Medicine. Experts in disciplines including virology, bioinformatics, wildlife conservation, biodefense, epidemiology, participatory research, and implementation science codeveloped behavior change and policy recommendations. Participatory exercises, including silent reflections, role-playing, and the "systems-thinking iceberg" enabled dynamic discussions that helped incorporate diverse perspectives. The team identified ways to overcome linguistic and discipline-specific language barriers, time differences, limitations to voluntary participation, and technological challenges. The frameworks and concepts that guided the team were the Consolidated Framework for Implementation Research, the principle that participatory approaches enable positive social learning, and the concept that interventions can be adapted to the local context but should not be reinvented. Participatory approaches can support One Health actor groups work toward a collective vision, which catalyzes a process that can improve local ownership, ultimately working to strengthen health security.