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Conspiracy Theories and Ebola: How a US Federally Funded Research Facility in the Heart of Sierra Leone’s Ebola Outbreak Acerbated Local Misconceptions about Ebola

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By: Caroline Duncombe

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An inherent distrust follows what one does not understand; scientific endeavors if not explained properly are easily misunderstood. From climate skeptics to CERN’s 666 logo, the world is wrought with conspiracy theories surrounding science. The role of conspiracies should not be underestimated or neglected, especially since such theories are interspersed with layers of truth. Usually conspiracies reside harmlessly on the edge of the web, but during the Ebola outbreak in Sierra Leone an unaddressed rumor resulted in fatal consequences. Rumors revolving around a Tulane University research facility located in Kenema Government Hospital prompted a breakdown in relations between the local populations and international health care workers. This mistrust led to the refusal to permit blood draws for diagnostic purposes during the critical initial stages of the Ebola outbreak. By underestimating the importance of cultural and religious symbolism surrounding scientific research U.S. federal funding agencies, laboratory researchers, and private companies made a crucial mistake. By analyzing this curious conspiracy theory, scientists, funding agencies, and health practitioners can learn from past mistakes and become more aware of the impact of research beyond pure scientific pursuit.

Background

            On May 24th, 2014,a young woman miscarried in Kenema Government Hospital. Given the recent outbreak in nearby Gueckedou, Guinea, Ebola was suspected. A day later, the same hospital reported the first confirmed case of Ebola in Sierra Leone. Soon after, Kenema became a hot zone – the entry point for the Ebola virus to spread throughout Sierra Leone and eventually the world. The repercussions of the Ebola outbreak extend well beyond the 11,310 death count in West Africa to economic, social, medical, and cultural spheres.

The Kenema Government Hospital was not a typical Sierra Leonian public hospital. In fact, the hospital was well-equipped, with the only Lassa fever isolation ward anywhere in the world. The lab dated to 2005, when Tulane University received a $10 million grant from the U.S. National Institutes of Health to study “Diagnostics for Biodefense against Lassa fever”. Since previous investigations of sporadic Lassa fever outbreaks were based out of Kenema, the natural choice for the establishment of first-rate laboratory infrastructure was Kenema Government Hospital.

As the years passed, the Tulane research laboratory acquired more grants and partnerships. One of the principal collaborators was the private for-profit company, Metabiota, which received grants from two U.S. Department of Defense (DoD) agencies – Defense Threat Reduction Agency and Biological Engagement Program – to primarily study the pathogenesis of Lassa fever, a ‘US bioterror threat’. Due to stipulations in NIH grant funding, the substantial amount of money flowing into this “shiny new” research laboratory could not be applied to assisting patients in the “dilapidated, cramped, and poorly resourced Lassa ward only some 50m away” (Bausch). During the Ebola outbreak, the Lassa laboratory’s focus shifted to Ebola, continuing research until the NIH did not renew funding in 2014, primarily due to safety reasons.

The Conspiracy Theory

Following the 2014 outbreak, a conspiracy theory circulating throughout Sierra Leone, essentially claiming that the U.S. created Ebola, or a Lassa-Ebola hybrid, and either intentionally or accidentally released this bioterror weapon from the U.S. NIH and DoD-funded research facility at Kenema Government Hospital. While such a rumor lacked credible evidence, there were specific circumstances surrounding the policies of the research outpost that fed into the narrative – truths that should have been addressed through culturally sensitive policies.

Four main factors converged into a superstitious and suspicious narrative about the Lassa research laboratory. First, by branding the Lassa research facility with a bioterrorism component, the project assisted in drawing out a natural conclusion that bioterror weapons were also present in the laboratory. Tulane University’s initial grant application in 2005 framed Lassa virus as a US biosecurity threat through key words such as “Diagnostics for Biodefense” and “LASV as a biological weapon directed against civilian or military targets necessitates development of… diagnostics.” The framing of the diagnostic development laboratory in terms of a biodefense strategy against the NIAID Category A classification was not an accident, but rather a necessity to gain funding. As Annie Wilkins puts it “whether the prospect of weaponization is regarded as sensationalism or a real concern, all researchers are aware of the utility the bioweapons threat has in obtaining funding.” By emphasizing biodefense and collaborating with the U.S. DoD via Metabiota’s funding stream, a natural linkage between the work of the research outpost and bioweapons developed.

The second factor was out of the control of Tulane University: A suspicious coincidence. Due to its proximity to Guinea, laboratory capacity, and fluidity in movement across the Sierra Leone-Guinea border, the first confirmed case of Ebola in Sierra Leone occurred in Kenema Government Hospital. Although there potentially were other cases of Ebola in Sierra Leone, none of the primary health care clinics in the area had the laboratory capacity to officially diagnose Ebola. A natural speculation ensued: what are the chances that the one Biodefense laboratory in Sierra Leone, where the hemorrhagic Lassa fever virus was located, was also the site of the first confirmed case of a “new” bioterror threat that also causes hemorrhagic fever, Ebola? Money draws attention, and the money flowing into this singular laboratory was substantial when compared with other public hospitals in Sierra Leone. For reference, the Sierra Leone Ministry of Health and Sanitation allocated U.S. $20 million budget to run the entire national health system in 2009.

Third, a nurse from Kenema Government Hospital claimed to an audience at a fish market that “the deadly [Ebola] virus was invented to conceal “cannibalistic rituals”. The statement and an already distrustful community culminated into a riot at the hospital on July 25th, 2014. Such a case further cemented the people’s suspicions that the laboratory was “stealing” the blood of Sierra Leonians. Even though collecting blood is necessary for diagnostic tests, there are many deeply held cultural beliefs about blood in Sierra Leone, and many people are reluctant to participate in blood test as a result.

Fourth, the research facility suspiciously and suddenly shut down right at the beginning of the outbreak without much explanation to the community. Additionally, many of the Sierra Leonian staff who could have addressed the suspicions about the facility pre-outbreak have since died while bravely combatting Ebola. All of these factors accumulated into the conspiracy theory that actors involved with the bio-defense grant and the US government created a bioterror weapon and unleashed it on West Africa.

Policy Considerations

The accumulation of these factors demonstrate the importance of cultural sensitivity and awareness when implementing scientific research policies. In 2018, Tulane University and a variety of partners received a new $15 million federally funded grant to study how Ebola and Lassa survivors fought off the diseases. Hopefully, the researchers are opening this facility with a new awareness and increased precautions on the spiritual and social baggage they bring to Kenema. This is especially important when considering the potential for further stigmatization of Ebola survivors if called to Kenema Government Hospital for research or treatment purposes.

There are several policy considerations that could alter the course of this conspiracy and help acclimate the community to both the presence of a well-equipped laboratory and blood draws for diagnostic purposes. Research institutions should refrain from using vocabulary such as “biodefense” and “bioweapon” to describe the purpose of research. A clinician in the Lassa ward pointed out that “The average Sierra Leonian won’t see Lassa Fever as a bioweapon threat. Only in the Western world do they see it like that.” Since the potential for contracting Lassa and Ebola is an everyday reality for Sierra Leonians, research initiatives on such diseases should be spoken about in terms of their potential for public health. Additionally, universities seeking to do medical research should consider the cultural significance of their location, and contemplate ways, including shifting location, that might reduce any negative connotations. Engaging influential spiritual leaders in productive information partnerships could also assist in assuaging local concerns.

Policy considerations should also be contemplated by grant funding institutions like the NIH and DoD. First, grant stipulations should integrate a layer of flexibility for distributing certain supplies and resources for patient care. Second, the NIH and DoD should be cognizant of their bias in funding grants that are written in terms of biodefense interests of the US, especially when related to countries where such a ‘bioweapon’ is an everyday reality. This is especially important because such bias incentivizes deleterious narratives that invokes cultural, social, and medical consequences.  Lack of funding for neglected infectious diseases that only burden developing countries by the US is a complex and important issue that will require deep structural changes – and would require another blog post to contemplate. Yet, a simple solution would be to require scientific grant applications to contain a section in which the applicant considers the cultural and social impact of the work within the community of interest. In addition, community outreach with intentional dialogue on assuaging concerns about sensitive research activities should made be mandatory.

The conspiracy theory exacerbated the already high level of mistrust in Western interventions during the outbreak. As the Washington Post emphasizes, the lesson from this case study is “that winning the trust of communities at risk is absolutely indispensable to limiting the impact of the inevitable next Ebola epidemic in West Africa.” Hopefully, the Tulane University research center in Kenema Government Hospital has learned from past mistakes, and seeks to engage the community and douse suspicions against their research upon re-opening the laboratory this year. Conspiracy theories usually integrate truth with speculation. The traditional method of ignoring such theories or flat out denying (as was the case with Tulane University) may have detrimental consequences as seen during the Ebola outbreak in Sierra Leone. The power in a conspiracy theory is not necessarily its truth, but it’s power to persuade people that it is true. And as scientists who are often focused on the facts, we often have a hard time understanding that concept. When doing research, it is crucial to be cognizant of the social perception of science and attempt to build bridges between gaps of understanding on cultural practices and scientific endeavors.

 

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Written by sciencepolicyforall

January 17, 2019 at 6:34 pm

Vaccination Politics: Exploring the policy measures needed to lower the risk of vaccine-preventable disease outbreaks

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By: Allison Cross, Ph.D.

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Source: Wikimedia

Thanks to modern medicine, many of the diseases that plagued our ancestors can now be prevented by vaccination.  Although there are no federal vaccination laws in the US, there are state laws making vaccination mandatory for children attending public schools. All 50 states require public school children to be vaccinated against diphtheria, tetanus, pertussis, polio, measles, rubella, and varicella (chicken pox). There are exceptions to these requirements, however, with all states allowing medical exceptions, 47 states allowing religious exemptions, and 17 states allowing personal belief exemptions.  A recent study published in PLOS medicine found that in states that allow personal belief exemptions, the rates of these exceptions has increased two-thirds in the last decade.  The study warns that numerous states and large metropolitan centers that have shown increases in non-medical exceptions (NMEs) may become increasingly vulnerable to outbreaks of vaccine-preventable disease.  This raises the question of whether policy measures should be taken to increase rates of vaccination.

Many parents who apply for personal belief exemptions for vaccinations do so because of concerns of vaccine safety and efficacy. The most influential milestone of the current anti-vaccination movement came in 1998 with an article published by Dr. A Wakefield in the Lancet linking the MMR vaccine to autism; the story was later featured on 60 minutes. Dr. Wakefield’s research has since been debunked, his paper has been retracted from the Lancet, and he was stripped of his medical license. Despite this, many parents remain fearful of vaccination and these fears continue to be fueled by the media, celebrities, and politicians.  While safety concerns keeps some parents from vaccinating their children, others choose not to vaccinate because they believe their children have a low risk of contracting vaccine preventable diseases due to their low prevalence.  Still others hold beliefs that natural immunity is better than vaccine acquired immunity.  In addition to personal beliefs against vaccination, some individuals oppose vaccination on the basis of their religious beliefs.

It is critical to maintain high vaccination rates among the population to provide protection to those who cannot be vaccinated or who have not yet developed immunity.This concept is known as herd immunity. There is a very small proportion of children that cannot be vaccinated due to medical reasons, but this small percentage of the population generally does not compromise herd immunity.  However, when parents refuse to vaccinate their children based on religious or personal beliefs, the percentage of unvaccinated children can rise and compromise herd immunity.   The percentage of the population that needs to be vaccinated for herd immunity to be effective depends on how contagious the germ is.  In 2017, the CDC reported that 83.4% of children from 19-35 months were vaccinated against diphtheria, tetanus and pertussis, 91.9% against polio, 91.1% against measles, mumps and rubella, and 90.6% against varicella.  Though these numbers may sound high they may not be high enough; for example the vaccination rate required to achieve herd immunity for measles is believed to be roughly 96% or higher.

Currently there are only three states that solely allow medical exemptions for school vaccination; Mississippi and West Virginia banned NMEs more than 30 years ago while California recently banned NMEs in January of 2016.  The strict rules on vaccination exemptions in Mississippi and West Virginia are linked to increased rates of vaccination.  In the 2014-2016 school year, over 99% of kindergarteners in Mississippi were reported to have received their MMR and DPT vaccines. On the contrary, states that permit both personal belief and religious exceptions are reported to have 2.5 times higher rates of vaccine exemptions.  California passed its statewide ban of NMEs after a 2015 measles outbreak that was linked to the Disneyland Resort in Anaheim, California.  Investigations into the outbreak reported that the exposed population had a vaccination rate of only 50-86%.  After passing the NME ban, California reported a record high level of vaccination with 95.6% of kindergarteners receiving all required vaccinations during 2016-2017.

Considering that the states that allow personal and religious exemptions to vaccination generally have higher levels of vaccine exemptions, one must consider whether more states should act to ban NMEs.   While these policies may increase vaccination rates, they may also come with other undesirable side-effects.  For example, although California reported a dramatic increase in vaccination rates following its ban of NMEs, a study by Mohanty S. et. al. also reported a significant increase (from 0.2% in 2015–2016 to 0.7% in 2017–2018) in medical exceptions, with the strongest increase reported in regions with high rates of personal belief exemptions prior to the NME ban.  This suggests that parents with personal beliefs against vaccination were able to find physicians willing to exercise “broader discretion” in providing medical exceptions.   Even more troubling, the study found that some physicians were charging steep fees to sign off on “medical” exceptions for parents who previously sought non-medical vaccination exemptions.  These findings suggest that the potential long-term benefit of the NME ban in California may not be achieved without further legal changes, including some form of standardized review of medical exemptions.

Though eliminating NMEs may be a successful means of raising vaccination rates to the levels needed to achieve herd immunity, other less drastic legislation changes may have similar results while respecting both the pro- and anti-vaccination viewpoints.  Some proposed alternatives include financial disincentives and stricter exception policies. Navin M.C. and Largent M.A.  proposed an “inconvenience approach”, which allows non-medical exceptions to continue but makes the application process more burdensome. Similarly, Billington J.K. and Omer. S.B. proposed the use of processing fees as a financial disincentive to discourage NMEs.  They suggest that states require annual renewal of NMEs and require a processing fee for each renewal.  They further recommend that these fees be administered in a “sliding-scale” to avoid income-based discrimination.  Billington and Omer argue that these fees will “help tilt the balance of convenience in favor of vaccination”.  Another approach could be requiring parental counseling on vaccine risks and benefits to obtain NMEs. After Washington state passed a law in 2011 requiring counseling intervention for NMEs they reported a relative 40.2% decrease in exception rates, with an absolute reduction of 2.9%.   Although elimination of NMEs is linked to higher vaccination rates, the less drastic proposals above could provide increased rates of vaccination without evoking the public backlash of eliminated NMEs entirely.

In states that allow medical and religious vaccination exemptions, policy makers attempting to crack down on religious exceptions can expect to face a lot of criticism from individuals who hold strong anti-vaccination beliefs.  In April, New Jersey lawmakers faced harsh criticism after advancing a proposal to make it harder for children to receive religious exemptions for vaccinations. New Jersey is among the 33 states that do not allow personal belief exemptions but permit both medical and religious vaccine exceptions.  Lawmakers decided to take action after noticing a dramatic increase in the number of children citing religion as a reason for refusing vaccination, from 1,641 students in the  2005-2006 school year to 10,407 children in 2016-2017. The proposed legislation would require parents to provide a notarized statement about their religious beliefs, including proof that their beliefs are ongoing, and to specifically explain how immunization conflicts with their religious tenets.  The proposed measured are intended to curb the percentage of parents who use the religious exceptions as a way to avoid vaccination due to personal beliefs or fears about vaccination.

Individuals who oppose vaccination, whether for religious or personal reasons, strongly believe that the government should not be able to force vaccination on anyone. However, childhood immunizations prevent serious illness and death along with billions of dollars of costs to society each year.  Furthermore, the choice not to vaccinate does more than effect the unvaccinated individual, as it also puts at risk those individuals who cannot receive vaccinations due to medication reason and those who have not yet developed immunity. Although rates of vaccine preventable diseases are currently very low in the US, the CDC has made it clear that maintaining high levels of vaccination is essential to prevent diseases from making a comeback. Strong anti-vaccination sediments and subpar MMR vaccination rates are being blamed for the current and ongoing measles outbreaks in Romania, France, Greece, and Italy; outbreaks across the EU have resulted in 33 deaths this year. It is clear that policies promoting vaccination are important for disease prevention but determining the best policy measures to increase vaccination rates, while considering the ethical debate of mandatory vaccination, while continue to be a struggle for policy makers.

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Written by sciencepolicyforall

December 20, 2018 at 9:37 am

Science Policy Around the Web – August 31, 2018

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By: Jennifer Patterson-West, Ph.D

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source: defense.gov

Public Health

Record High Number of STD Infections in U.S., As Prevention Funding Declines 

This week at the biennial 2018 National STD Prevention Conference sexual health professionals, including scientists and clinician, discussed new prospects to improve the health of our communities at a time when STD rates are on the rise.

The United States has the highest rate of sexually transmitted diseases (STD) in the industrial world.  Preliminary data indicates that nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in 2017.  These numbers reflect an increase in gonorrhea cases by 67% and syphilis by 76% over the past 4 years.

The director of the Center of Disease Control (CDC)’s division of STD prevention, Dr. Gail Bolan warns that “we’ve been sliding backwards” in our efforts to control STDs.  A major challenge in mitigating the spread of STDs is that the majority of individuals that carry the disease display no symptoms and remain unaware that they are infected.  For this reason, annual testing for chlamydia and gonorrhea is recommended for sexually active women under the age of 25 and males with male partners.  Patients are strongly encouraged to request STD testing because not all doctors will habitually offer these tests.

David Harvey, executive director of the National Coalition of STD directors, notes that congenital transmission of syphilis is diagnosed in a thousand babies annually despite the virtual eradication of HIV transmission from mother to child.   The continued occurrence of congenital syphilis, which can cause birth defects or result in stillbirth, is shocking due to the fact that syphilis can be effectively treated by antibiotics if caught early.

David Harvey emphasizes that a key factor in this growing health crisis is a roughly 40 percent drop in funding for the prevention and control of STDs over the past 15 years.  Taking into account that more than 50 percent of all Americans will contract an STD in their lifetime, the prevalence of STDs in the U.S. is a health crisis that needs to be addressed before our current methods of treatment are no longer effective. For instance, 4 percent of Neisseria gonorrhoeae patient samples are now resistant to antibiotic treatment. This Illustrates the need for new treatment options and the increased engagement with the public to encourage testing and the use of preventative measures.

(Richard Harris, NPR)

The Environment

Will More Logging Save Western Forests from Wildfires? 

According to the National Interagency Fire Center there have already been 38,832 wildfires this year.  Approximately 90 percent of these are human-caused due to negligence or intentional acts.

Given suitable environmental conditions, something as inane as the sparks from a flat tire has the potential to cause a catastrophe.  These circumstances are what caused the Carr Fire in Redding, California that burned over 200,000 and destroyed more than a thousand homes.

Recent disasters have people looking for preventative measures to minimize the occurrence and spread of wildfires.  In response, the Trump administration is promoting the expansion of logging in western states.  The administration emphasizes that environmental regulations are magnifying this issue.  Senator Steve Daines (R-Mont.) proposed a bill, Protect Collaboration for Healthier Forests Act, to accelerate forest management projects by reducing legal appeals.

However, forest and industrial experts counter that a sustainable solution is actually more involved and expensive then the simple expansion of logging.  Bill Oliver, a retired forest official, stresses that the forests are too dense and that bushes and small diameter trees that fuel mega fires are what need to be cleared. Conversely, it is the larger trees that are coveted by the timber industry and consumers.

However, one of California wood producer’s Sierra Pacific industry is investing in upgrading systems to use smaller diameter wood to produce commercial products, such as particle board. Dan Tomascheski, the vice president of Forest Resources for Sierra Pacific Industries, asserts that industry will need reassurances that use of public lands will not be a short-term initiative.

The Forest service affirms that nationwide there are approximately 80 million acres of forest lands at high risk of major fires with only two million have been treated thus far. Despite the potential benefit of forest management project, Forest management consultant Rich Armstrong emphasizes that budget cuts for wildfire mitigation and other forest programs are the biggest enemy to forest management. A separate fund to pay for wildfire suppression has recently been passed in congress due to bi-partisan efforts and will go into effect next year.

(Kirk Siegler, NPR)

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August 31, 2018 at 5:25 pm

Science Policy Around the Web – April 29, 2017

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By: Saurav Seshadri, PhD

digital forensics 5” by jon crel is licensed under CC BY 2.0

Forsensic Science

Now Who Will Push Ahead on Validating Forensic Science Disciplines?

The realities of forensic science remain far removed from the white-coated wizardry depicted on shows like CSI. Although forensic results often heavily influence criminal trials, there is a substantial gap between the perceived and true reliability of commonly used methods such as fingerprint and bitemark identification. The National Commission on Forensic Science (NCFS) was established in 2013 to help close this gap, by promoting rigorous, independent evaluation of forensic techniques, as well as communication between law enforcement agencies and academic scientists. The NCFS was supported jointly by the Department of Justice (DOJ) and National Institutes of Standards and Technology (NIST), and has published over forty documents reflecting the consensus of scientists, lawyers, law enforcement officers, and other stakeholders.

Recently confirmed Attorney General Jeff Sessions has decided not to renew the NCFS’ charter, which expired on April 23, 2017. Its work will ostensibly be taken over by a new entity, which will be developed by a DOJ Subcommittee on Forensics and spearheaded by an as-yet-unnamed, DOJ-appointed Senior Forensic Advisor. The DOJ is currently seeking input on how best to organize this initiative, but its actions already suggest an unwillingness to follow expert guidance, such as the original recommendations from the National Academy of Sciences that led to the creation of the NCFS. The recommendations include ‘[t]his new entity must be an independent federal agency…[i]t must not be part of a law enforcement agency’ and ‘…no existing or new division or unit within DOJ would be an appropriate location for a new entity governing the forensic science community’.

Despite this setback, some of the NCFS’ contributions, such as promoting acceptance of the need for licensing and accreditation, may have a lasting influence on the field. In the NCFS’ absence, NIST is expected to play a central role in coordinating the forensic science community. Support for these efforts will be critical to improving standards in forensic practice, and ultimately, to providing justice to the American public. (Suzanne Bell, The Conversation)

Infectious Disease

Ghana, Kenya and Malawi to Take Part in WHO Malaria Vaccine Pilot Program

While interventions such as insecticide-treated mosquito nets have dramatically reduced malaria-related deaths, almost half a million people still die annually from the disease, predominantly children in sub-Saharan Africa. Continuing the fight against malaria, the World Health Organization Regional Office for Africa (WHO/AFRO) has announced that a pilot program to test the world’s first malaria vaccine will begin in 2018. The vaccine (RTS,S or MosquirixTM) is the result of over $500 million in investment from GlaxoSmithKline and the Bill & Melinda Gates Foundation. It has shown promising results in Phase 3 trials, reducing rates of malaria by almost half in children treated at 5-17 months old. Following guidance from two independent advisory groups, the WHO will implement the vaccine in three countries that have high malarial burdens despite ongoing, large-scale anti-malaria efforts. The first stage of the program, which is being funded by several international health organizations in addition to WHO and GSK, will span 2018-2020, with final results expected in 2022.

RTS,S has followed an unconventional route to its current stage of development. It was approved by the European Medicines Agency (EMA) under Article 58, a mechanism that allows the EMA’s Committee for Medicinal Products for Human Use (CHMP) to collaborate with the WHO and international regulatory agencies to evaluate drugs intended for use in developing countries. However, in the first ten years after its inception in 2004, just seven drugs received positive opinions from CHMP through Article 58, and among these, the EMA has reported limited commercial success. This track record, combined with the emergence of more attractive incentive programs to develop drugs for tropical diseases (including a priority review voucher system launched by the FDA in 2007), has raised questions about Article 58’s effectiveness. A positive outcome for RTS,S could revitalize the program and lead to more innovative treatments for vulnerable populations worldwide. (WHO/AFRO press release)

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April 29, 2017 at 8:56 pm

Science Policy Around the Web – July 26, 2016

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By: Ian McWilliams, Ph.D.

photo credit: Newport Geographic via photopin cc

Infectious Diseases

Research charities help marry two major South African HIV/TB institutes

Two institutes, the Wellcome Trust and the Howard Hughes Medical Institute (HHMI), have announced that they are joining efforts in to fund the fight against HIV and Tuberculosis (TB) in South Africa. South Africa has the largest population infected with HIV. Because TB thrives in HIV-infected individuals, South Africa is experiencing a co-epidemic that has been challenging to battle. This collaboration will mark the first time that HHMI and The Wellcome Trust have worked together on a global health institution.

The new Africa Health Research Institute combines the Africa Centre for Population Health’s detailed population data gathered from over 100,000 participants with basic laboratory science and medical research of the KwaZulu-Natal Research Institute TB-HIV (K-RITH). Together the organization will work towards eliminating HIV and TB by training African scientists and will “link clinical and laboratory-based studies with social science, health systems research and population studies to make fundamental discoveries about these killer diseases, as well as demonstrating how best to reduce morbidity and mortality.” Projects funded by the institute include maintaining the longest running population-based HIV treatment as prevention (TasP) trial in Africa and using genomics to study drug resistant TB.

The organization is funded by a $50 million grant from The Wellcome Trust that is renewable over the next five years. Additionally, HHMI has already spent $40 million for the construction of new facilities, including a new biosafety level 3 laboratory that is designed to handle dangerous pathogens. These new efforts aim to apply scientific breakthroughs to directly help the local community. Deenan Pillay, the director of the new institute, has expressed his support of the organization’s mission by stating “There’s been increasing pressure and need for the Africa Centre not just to observe the epidemic but to do something about it. How long can you be producing bloody maps?” (Jon Cohen, ScienceInsider)

Scientific Reproducibility

Dutch agency launches first grants programme dedicate to replication

While a reproducibility crisis is on the minds of many scientists, the Netherlands have launched a new fund to encourage Dutch scientists to test the reproducibility of ‘cornerstone’ scientific findings. The €3 million fund was announced on July 19th by the Netherlands Organisation for Scientific Research (NWO) and will focus on replicating work that “have a large impact on science, government policy or the public debate.”

The Replication Studies pilot program aims to increase transparency, quality, and completeness of reporting of results. Brian Nosek, who led studies to evaluate the reproducibility of over 100 reports from three different psychology journals, hailed the new program and stated “this is an increase of infinity percent of federal funding dedicated to replication studies.” This project is the first program in the world to focus on the replication of previous scientific findings. Dutch scientist Daniel Lakens further stated that “[t]his clearly signals that NWO feels there is imbalance in how much scientists perform replication research, and how much scientists perform novel research.” The NWO has stated that it intends to include replication in all of its research programs.

This pilot program will focus both on the reproduction of findings using datasets from the original study and replication of findings with new datasets gathered using the same research protocol in the original study. The program expects to fund 8-10 projects each year, and importantly, scientists will not be allowed to replicate their own work. The call for proposals will open in September with an expected deadline in mid-December. (Monya Baker, Nature News)

Health Care Insurance

US Sues to block Anthem-Cigna and Aetna-Human mergers

United States Attorney General Loretta Lynch has announced lawsuits to block two mergers that involve four of the largest health insurers. Co-plaintiffs in the suits include eight states, including Delaware, Florida, Georgia, Illinoi, Iowa, Ohio, Pennsylvania, Virginia, California, Colorado, Connecticut, Main, Maryland, and New Hampshire, as well as the District of Columbia. The lawsuits are an attempt by the Justice Department to block Humana’s $37 billion merger with Aetna and Anthem’s $54 billion acquisition of Cigna, the largest merger in the history of health insurers. The Justice Department says that the deals violate antitrust laws and could mean fewer choices and higher premiums for Americans. Antitrust officials also expressed concern that doctors and hospitals could lose bargaining power in these mergers.

Both proposed mergers were announced last year, and if these transactions close, the number of national providers would be reduced from five to three large companies. Furthermore, the government says that Anthem and Cigna control at least 50 percent of the national employer-based insurance market. Lynch further added that “competition would be substantially reduced for hundreds of thousands of families and individuals who buy insurance on the public exchanges established under the Affordable Care Act.” The Affordable Care Act (ACA) aimed to encourage more competition between insurers to improve health insurance options and keep plans affordable. The Obama administration has closely watched the health care industry since the passing of that legislation and has previously blocked the mergers of large hospital systems and stopped the merger of pharmaceutical giants, such as the proposed merger of Pfizer and Allergan.

Health insurers argue that these mergers are necessary to make the health care system more efficient, and would allow doctors and hospitals to better coordinate medical care. In reaction to the announcement by the Justice Department, Aetna and Humana stated that they intend to “vigorously defend” the merger and that this move “is in the best interest of consumers, particularly seniors seeking affordable, high-quality Medicare Advantage plans.” Cigna has said it is evaluating its options. (Leslie Picker and Reed Abelson, New York Times)

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July 26, 2016 at 11:00 am

Science Policy Around the Web – January 29, 2016

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By: Daniël P. Melters, Ph.D.

Infectious Diseases

Zika virus, linked to microcephaly, on the rise

Only a few months after the scare of the epidemic of chikungunya, a new virus has emerged on the American continents: Zika virus. The same mosquito (Aedes aegypti) that transmits yellow fever, dengue, and chikungunya also transmits this virus. In the last few months of 2015, there was a sharp rise in babies born with microcephaly. Some hospitals in north Brazil that would only see five cases a year, now see over 300 in six months. These babies have abnormally small heads and the rare neurological disorder Guillain-Barré syndrome. The rise in cases with microcephaly strongly correlated with an ongoing Zika virus epidemic in the north of Brazil. In addition, the Zika virus RNA was found in the amniotic fluid of two fetuses. It is thought that women who were pregnant became infected with the virus and gave it to the growing fetus. Nevertheless, there is no formal evidence that the Zika virus causes microcephaly. In fact, a recent report argues that a surge in finding birth defects is too blame for the increase in microcephaly cases in Latin America.

This has not stopped local and global authorities from warning people of the potential dangers of the Zika virus. Brazil has suggested its citizens in affected regions not get pregnant. The CDC in the U.S. is warning tourists who go to regions where Zika virus is epidemic to take precautionary measures to prevent being bitten by mosquitos. On Thursday, January 28th, the World Health Organization declared an International Emergency. The last International Emergency was the Ebola outbreak in West Africa. Another complicating factor is the expected increase in number of mosquitos due to El Niño. Although most people who get infected by Zika virus will remain asymptomatic, some people will have a rash and a fever. As of now, no cure exists. Therefore, researchers around the world are rushing to develop a vaccine. Two potential vaccines against West Nile virus, after being repurposed for Zika, might enter clinical trials as early as late 2016, according to Dr. Fauci (NIH/NIAID) [recent talk by Dr. Fauci on emerging viruses]. But caution about a quick cure is warranted, as it might take several years before a Zika vaccine becomes commercially available. (, BBC News website)

Mental Health

One step closer to understanding schizophrenia

Schizophrenia is a debilitating psychiatric disease that affects over two million people in the United States alone. Often, this disease start in the later years of adolescence and early adulthood. Delusional thinking and hallucinations characterize schizophrenia, but the drugs available to date to treat schizophrenia are blunt and frequently patients stop using them because of their side effects. Although this new study will not lead to new treatments on the short term, it does provide researchers with first firm biological handle on the disease.

The developing human brain is the site of neuronal pruning. At first, the brain makes an excessive number of connections between neurons, but as children grow-up, most of these redundant connections are lost. You can see this a competition between the connections where the strongest ones survive. Neuronal pruning in the prefrontal cortex, the part of the brain involved in thinking and planning, happens in adolescence and early adulthood. The latest finding, published in Nature, found that people who carry genes that accelerate or intensify that pruning are at higher risk of developing schizophrenia than those who do not. To date, no specific genetic variant has been found, although the MHC locus seems a likely candidate. Indeed, one specific gene in this locus, C4 gene, is involved in neuronal pruning. The C4 gene produces two products: C4-A and C4-B. Too much of the C4-A variant results in too much pruning in mice, which would explain why schizophrenic patients have a thinner prefrontal cortex. These new findings help to connect the dots better than ever before. Next up will be developing drugs that regulate neuronal pruning and the hope is that this will create a new anti-schizophrenia drug. (Benedict Carey, New York Times)

Technology

Analyzing body chemistry through sweat sensor

A small, wearable sensor has been created that can measure the molecular composition of sweat send those results in real time to your smartphone. The sensor, a flexible plastic patch, can be incorporated into wristbands. Several labs have been working on developing such a patch for a while, but most of them could only detect one molecule at a time. This newly developed flexible printed plastic sensor can detect glucose, lactate, sodium, potassium, and body temperature. When the sensor comes in contact with sweat an electrical signal is amplified and filtered. Subsequently, the signal is calibrated with the skin temperature. This latter step is essential, according to the lead scientist Jarvey. The data is then wirelessly transmitted to your smartphone. Because the sensor is not as accurate as a blood test, rigorous testing for medical use is therefore required.

The potential of this new devise is that it can tell, for instance, a diabetic patient in real-time that his blood sugar levels are too low or too high. It could also tell someone who is physically active that she is getting dehydrated and needs to drink water. One particular project could greatly benefit from this new technology. Last year President Obama announced the Precision Medicine Initiative. The goal of this initiative is to enroll over one million American participants and follow them over time to learn about the biological, environmental, and behavioral influences on health and disease. After all, most disease still do not have a proven means of prevention or effective treatments. Having technology such as this that can monitor and track basic biological data in real time could provide a wealth of information to researchers looking to make connections between a person and a disease.  (Linda Geddes, Nature News)

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Written by sciencepolicyforall

January 29, 2016 at 9:00 am

Global Occurrence of Zoonotic Tuberculosis: Ongoing Efforts…

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By: Ashley Parker, Ph.D.

photo credit: via photopin (license)

Tuberculosis (TB) is a disease transmitted via droplets from the throat and lungs of infected individuals, and is caused mainly by the bacterium Mycobacterium tuberculosis. According to the 2015 Global TB report published by the World Health Organization (WHO), TB affects millions of people every year and ranks alongside the human immunodeficiency virus (HIV) as the leading cause of death worldwide; in addition, 9.6 million new cases of TB were estimated in 2014. We typically think of TB as a disease that is spread from person-to-person; however Meera Senthilingam, writer for CNN, recently published an article about the transmission of TB from infected animals to humans, highlighting the spread of tuberculosis via a contaminated food source that originated in a cow infected with Mycobacterium bovis.

Although M. bovis causes less than 2% of the total number of TB cases in the United States (less than 230 cases per year), according to the Centers for Disease Control and Prevention (CDC), the organism is also found in cattle and other animals such as bison, elk, and deer. “An increase in the number of cattle-associated cases in the U.S. was found to be near the Mexico border and among the Hispanic communities,” and was reported to be associated with the ingestion of unpasteurized milk and dairy products such as raw cheese, according to a speaker at the 46th World Conference on Lung Health. In California, the incidence of tuberculosis caused by M. bovis has increased recently. Of the approximately 19,000 patients who were enrolled in the states’ tuberculosis registry between 2003 and 2011, 3.4% of 2,384 cases were infected with M. bovis in 2003, increasing to 5.4% of 1,808 cases in 2011, with six cases having an association with at least one parent or guardian born in Mexico (Gallivan M, et al.). In an effort to manage the incidence and spread of bovine TB, the state of California is implementing strategies to limit the demand and distribution of unpasteurized milk and dairy products.

In other countries such as the United Kingdom, bovine TB is a major challenge for cattle farming industries, particularly in the west and southwest regions of England. In an effort to eradicate bovine TB, the UK government has developed actions outlined in their Bovine TB Strategy for England and UK Bovine TB Eradication Program, which include testing cattle herds for bovine TB and controlling TB in herds when detected, controlling the disease in badgers, improving biosecurity and husbandry on farms, developing TB vaccines for cattle, vaccinating badgers against TB, helping other industry sectors to deal with TB in non-bovine species, and developing the comprehensive bovine TB research program. According to a report by the CDC, many countries, particularly developing countries with limited resources, lack the ability to report all TB cases because of the difficulties with identifying suspected cases and establishing a diagnosis, and issues with recording and reporting cases. Another study presented at the 46th Union World Conference on Lung Health suggested that improper diagnosis and inadequate treatment was occurring in developing regions. In this study, “3,595 cattle and 266 livestock workers in Nigeria were screened for bovine TB; 10.4% of individual cattle, 42.9% of herds, 4.6% of butchers, and 6.1% of marketers were positive for tuberculosis.” There were major concerns about bacterial resistance, considering M. bovis is naturally resistant to pyrazinamide, a first line drug used as a standard treatment. Unfortunately, the CDC reports, of the 55 African countries, only 7 apply disease control measures as part of a test-and-slaughter policy and consider bovine TB to be a notifiable disease, while the remaining 48 apply inadequate control strategies or fail to control the disease. This leaves 85% of cattle and 82% of the human population exposed to bovine TB that is inadequately controlled or not controlled at all. In general, evaluation of M. bovis is not a routine part of laboratory testing for tuberculosis complex isolates, therefore most patients with the disease are not recognized. According to an article by Elizabeth Talbot, MD, the initial diagnostic approach for M. tuberculosis is also standard for M. bovis, including acid-fast staining, mycobacterial culture of relevant specimens, molecular testing for mycobacterial DNA, tuberculin skin test, and interferon gamma release assays. However additional tests should be requested in settings where M. bovis has high incidence rates or may be suspected, in an effort to properly identify the species. These tests include susceptibility testing, biochemical assays, and genomic analysis.

The spread of human M. bovis is a recognizable public health issue that is capturing attention in the United States and abroad. Although this organism primarily poses challenges in developing countries, the WHO recognized the importance and potential threat of human M. bovis in 1950 in the report of the Expert Committee on Tuberculosis. Recently, collaborative efforts have been made to eliminate bovine TB, involving WHO’s Division of Emerging and other Communicable Diseases Surveillance and Control, Veterinary Public Health program of the WHO Regional Office for the Americas, Pan American Health Organization, and additional working groups including the Food and Agriculture Organization of the United Nations, Office International des Epizooties Consultation on Animal Tuberculosis Vaccines. Successful vaccinations for cattle (developed in 1998 by WHO and organizations listed above) are currently being used in some countries. Plans to eradicate the disease are underway in specific countries, and are also part of a global 10-year plan, but will require better epidemiological surveillance to identify high risk areas, and properly implement control and elimination programs. Also, educating and notifying the public about the potential risk factors will help in the prevention of bovine TB.

Written by sciencepolicyforall

January 6, 2016 at 9:00 am