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Technologies to Address Global Catastrophic Biological Risks – Tara Kirk Sell


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A presentation by Tara Kirk Sell of the Johns Hopkins Center for Health Security on Technologies to Address Global Catastrophic Biological Risks.

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Technologies to Address Global Catastrophic Biological Risks – Tara Kirk Sell

  1. 1. Technologies to Address Global Catastrophic Biological Risks Tara Kirk Sell, PhD Assistant Professor, Johns Hopkins Center for Health Security Special thanks to Crystal Watson, DrPH, MPH Lead Project PI
  2. 2. Global Catastrophic Biological Risks (GCBRs) ►Global Catastrophic Risks are a class of risks – naturally or technologically driven – that have potential to inflict serious damage to human wellbeing on a global scale ►GCBRs might include: ►Naturally occurring severe pandemics ►Deliberately created and released pathogens ►Laboratory engineered and escaped pathogens
  3. 3. Why We Chose This Focus • Few past analyses have focused on technologies to prevent or respond to pandemics • None have addressed GCBRs • Technology development for infectious disease pandemics primarily focuses on vaccine development • Other technologies are often neglected
  4. 4. Opportunities for Intervention in Severe Pandemics
  5. 5. Categories of Applicable Technologies
  6. 6. Project Approach • Structured exploration of extant and emerging technologies with the potential to radically alter the trajectory of severe infectious disease events with catastrophic potential • Goals: • ID areas of need for tech solutions to address pandemic and GCBRs; • ID technologies that have significant potential to reduce GCBRs; and • Provide context for those technologies • Uses: results should be used to guide further detailed analyses
  7. 7. Technology Properties • Properties that transformative technologies in GCBR reduction would likely possess: • Approaches that are distributed rather than centralized • Ability to increase the capacity to make response decisions earlier • Rugged or easy to use in a variety of settings • Ability to reduce time lags in development/delivery of treatment/countermeasures
  8. 8. Technology Identification Process • Technology Scan and Review of the Literature • Structured review using key words • Review of both grey and peer-reviewed literature • Resulted in identified themes and individuals for interview • Semi-Structured Interviews with Experts • Using snowball sampling (asking for recommendations), we identified experts • Asked a series of questions about technologies and their applicability to pandemics and GCB events • After each interview, the team met and identified technologies for further review
  9. 9. Technology Evaluation Process • Series of standardized questions • Questions were modeled on the Heilmeier Catechism: Process used by George Heilmeier for the Defense Advanced Research Projects Agency (DARPA) • Our Questions: • What is the technology? • What problem does it solve? • How do we do it now? • What does success look like?
  10. 10. Results 10
  11. 11. Categories of Applicable Technologies
  12. 12. Disease Detection, Surveillance, and Situational Awareness Technologies
  13. 13. • What is the technology? • Rapid, accurate, affordable, and fieldable nucleotide sequencing for detection of pathogens in human and environmental samples – nanopore sequencing • What problem does it solve? • Sequencing can be used to detect novel or unexpected pathogens, whereas other molecular diagnostics like PCR only test for known pathogens • How do we do it now? • Prior to nanopore, sequencing was centralized and laboratory-based • What does success look like? • Ubiquitous sequencing will allow for the near real-time characterization of pathogen biology, including determinations of virulence, transmissibility, sensitivity or resistance to medicines or vaccines. Ubiquitous Genomic Sequencing and Sensing
  14. 14. • What is the technology? • Drone networks sampling air, water and soil and processing biological samples onboard • What problem does it solve? • Help detect an aerosolized attack or potentially catastrophic change in aquatics ecosystems • How do we do it now? • Environmental surveillance is conducted on a small scale, and is not networked • What does success look like? • A network of land, sea, and air-based drones autonomously conducting environmental surveillance 14 Drone Networks for Environmental Detection
  15. 15. 15 Remote Sensing for Environmental Pathogens • What is the technology? • Satellite imagery that measures intensity and color bands of reflected light from plants to determine health • What problem does it solve? • Early detection of a plant pathogen that might devastate the world’s crops • How do we do it now? • Individual farmers monitor their land and report problems to the national plant diagnostic network or US Department of Agriculture • What does success look like? • The technology exists, but its widespread use for monitoring does not. A national organization charged with monitoring and acting on identified threats could improve agricultural biosecurity
  16. 16. Infectious Disease Diagnostics
  17. 17. 17 Microfluidic Devices • What is the technology? • Small lab-on-chip or paper diagnostics with very rapid results. • What problem does it solve? • Paper diagnostics can be used in the field to diagnose, enable treatment, and help with isolation and quarantine • How do we do it now? • Most diagnostics are processed in centralized laboratories requiring days of processing time • What does success look like? • Low cost point of care confirmatory testing would decrease time to diagnosis, isolation, and treatment. It could enable social distancing and help slow disease spread
  18. 18. 18 Hand-Held Mass Spectrometry • What is the technology? • Portable handheld mass spectrometers for identification of pathogen-specific proteins • What problem does it solve? • Reduction in the time to specific identification of a pathogen • How do we do it now? • Culture is still the gold standard, but it takes time and cannot be done in the field • What does success look like? • Diagnostic for a wide range of pathogens in the field, with very high sensitivity and specificity
  19. 19. 19 Cell-Free Diagnostics • What is the technology? • Cell-free diagnostics take bioengineered cellular machinery from lysed cells, freeze dries these components, and uses them for diagnosis • What problem does it solve? • It provides cheap, accurate, and portable diagnostics • How do we do it now? • Diagnostics like polymerase chain reaction (PCR) require laboratories and expensive equipment • What does success look like? • Cell-free diagnostics could be rapidly manufactured and distributed widely
  20. 20. Distributed Medical Countermeasure Manufacturing
  21. 21. 21 Synthetic Biology for MCM Manufacturing • What is the technology? • Genetically engineered strains of chassis bacterial organisms, such as yeast can be programmed to manufacture drugs and vaccines • What problem does it solve? • Discovery, availability, and accessibility of drugs and vaccines in a pandemic or GCB event • How do we do it now? • Centralized manufacturing by pharmaceutical companies • What does success look like? • Synthetically modified bacteria could be distributed around the world for production in bioreactors. Even breweries could be harnessed in worst case scenarios
  22. 22. 22 3D Printing of Chemicals and Biologics • What is the technology? • 3D printing (additive manufacturing) of drugs and vaccines • What problem does it solve? • Even when a drug or vaccine is developed in time to respond to a pandemic, getting access to them will be difficult in many parts of the world. 3D printers could be used in doctors’ offices, pharmacies, and even at home • How do we do it now? • Most MCM manufacturing occurs at centralized sites and on dedicated platforms • What does success look like? • 3D printing could allow for greater and earlier access to medical countermeasures developed in response to or identified in a GCB event
  23. 23. Medical Countermeasure Distribution, Dispensing, and Administration
  24. 24. 24 Microarray (Microneedle) Patch Vaccines • What is the technology? • Microarray patches can be used in place of needle and syringe for vaccination • What problem does it solve? • With needle and syringe, you need healthcare providers to administer vaccines. MAPs eliminate that need • How do we do it now? • Vaccines can be given only by healthcare providers • What does success look like? • Elimination of needle and syringe, and move toward self- administration for vaccines in a pandemic or GCBR
  25. 25. 25 Self-Spreading Vaccines • What is the technology? • Self-spreading, also known as transmissible or self-replicating vaccines, are genetically engineered to move through populations like viruses, but to confer protection instead of causing disease • What problem does it solve? • Many people will not get access to vaccines in time to make a difference in a GCBR • How do we do it now? • Traditional vaccination models • What does success look like? • Transmissible vaccines could help protect populations of wild animals that might harbor zoonotic diseases. They could also be used to protect human populations quickly in a severe pandemic
  26. 26. 26 Ingestible Bacteria for Vaccination • What is the technology? • Ingested capsules of bacteria are released in the gut, encounter macrophages and are phagocytosed. Within the macrophage, the bacteria begin to express antigens that stimulate the immune system. • What problem does it solve? • Because antigen is made within the body’s own cells and not passively introduced, the vaccine is as or more effective than traditional vaccines. • It also simplifies production, storage, administration • How do we do it now? • Vaccine and syringe, and less-effective oral vaccines • What does success look like? • Rapid manufacturing of capsules to be delivered around the world for easy administration
  27. 27. 27 Drone Delivery to Remote Locations • What is the technology? • Unmanned aerial delivery of medical countermeasures and supplies to remote locations • What problem does it solve? • Drones can reach locations that cannot be accessed by traditional supply chains. They can also reduce spread of disease by enabling delivery without personal contact • How do we do it now? • Medical supply chains use ground-based transportation, which may not be functional during a pandemic • What does success look like? • Drone networks available to deliver MCMs and supplies around the world
  28. 28. 28 Synthetic Vaccinology: Self- Amplifying mRNA Vaccines • What is the technology? • SAM vaccines use the genome of a modified RNA virus to introduce an antigen of interest and replicate in the body • What problem does it solve? • Safer and easier to deliver than other nucleic acid vaccines • Reduces dose needed, and induces a broader immune response than other vaccines • How do we do it now? • Viral vectors hampered by immune response and have risk of reversion to wild type • Large amounts of antigen and sometimes multiple doses and difficulty manufacturing • What does success look like? • Fast, dose-sparing technology could mean a vaccine that is available rapidly and can protect many more people
  29. 29. Medical Care and Surge Capacity
  30. 30. 30 Robotics and Telehealth • What is the technology? • A suite of technologies that allow care to be provided without the physical presence of a healthcare provider. • What problem does it solve? • They can augment medical surge capacity – i.e. too many patients, not enough HCWs • How do we do it now? • Routine medical model • What does success look like? • Mass care provided to large populations without hospitalization or contact with the traditional healthcare system
  31. 31. 31 Portable, Easy to Use Ventilator • What is the technology? • Respiratory support that’s usable by non-expert care providers • What problem does it solve? • Allows for care of the severely ill during pandemics of respiratory disease • How do we do it now? • Critically ill patients are admitted to ICU’s, where they are intubated and managed by highly expert care teams • What does success look like? • Respiratory support is able to be provided outside of ICU’s – potentially in alternate care sites
  32. 32. Conclusions ► Technologies – while not a panacea – will be a critical part of the response to severe pandemics and GCBR’s ► Horizon scanning is a useful exercise to identify new technologies and use cases ► Scalable technology solutions will be needed if we’re going to protect the health of 8 billion + individuals ► Fortunately, with a few exceptions, most of the technologies that we think could make a difference either already exist, or are linear projections of the state of the art
  33. 33. Call to Action ► Innovative thinking, a willingness to bend the rules, and a certain amount of risk taking will be required if humanity faces a major pandemic ► Routine and ongoing technology horizon scanning is needed to identify risks and benefits ► Dedicated thought and resources are needed to integrate technologies into practice in preparation for the next pandemic ► The next step is to do further analysis on use cases and viability of the highlighted technologies
  34. 34. THANK YOU! Contact Information Tara Kirk Sell