In September 2023 the Pandemic Centre at Brown University School of Public Health shared a publication that emphasises the importance of “identification, attribution, and consequence management” of pathogen releases in Africa. The report offers a “roadmap” for the preparation for accidental or deliberate release, comprising “expert input” from “those on the frontlines”. In this piece we explore the guidance that is offered, which is intended for application “to a range of settings” apart from the specific geography that is used. To read the report in full click here, and don’t forget to let us know what you think!
A roadmap for preparation
The report begins with a foreword from Director, DrPH Jennifer Nuzzo, who comments on the “direct evidence” from COVID-19 that societies are vulnerable to biological threats.
“As governments move on from the pandemic emergency, we should not forget how much we’ve lost during this crisis – a consequence of our lack of preparedness for biological threats.”
DrPH Nuzzo emphasises that our preparedness for “future biological emergencies” depends on recognition of “other plausible disease scenarios” that could threaten “health, peace, and prosperity”. These scenarios include the two of the “most challenging”: accidental or deliberate release of a deadly biological agent. She suggests that the report will offer a “roadmap”; although it is addressed to a “particular geography in mind (Africa)”, the authors make it clear that the recommendations have relevance elsewhere.
“We may hope that future biological crises don’t occur, but hope is not a strategy for being prepared.”
The executive summary acknowledges that African countries are “by no means alone in lacking the tools” to respond to incidents caused by accidental or deliberate pathogen release. However, the policy brief is focused on Africa.
The importance of origins
Three types of outbreaks are presented as threats to public health:
- Naturally occurring – those resulting from the transmission and spread of infectious diseases in the absence of human intervention of through human contact with wildlife
- Those caused by accidental pathogen release – caused by laboratory mishap, unintended pathogen releases linked to lawful or illicit activities, or human error in handling dangerous materials
- Those caused by deliberate pathogen release – intentional release or dissemination of pathogens to cause harm, instil fear, or disrupt societies
The authors suggest that “recent growth in laboratory systems” and “widespread access to innovative but potentially dangerous technologies” create a “new species of trouble. This requires a “re-evaluation of the threat landscape”. African countries have protocols addressing naturally occurring outbreaks, but “fewer policy measures” to govern accidental or deliberate outbreaks.
There are several reasons for the importance of determining the origin or an outbreak as identified in the report:
- Identify the source – this is crucial for implementing effective control measures to prevent the further spread of the disease
- Understand the epidemiology of the disease – this informs public health policies and interventions
- Identify potential risk factors for the disease – this can inform prevention strategies
- Alleviate public anxiety and fear (as demonstrated by the COVID-19 pandemic)
- Where accidental, identify which threat and risk reduction measures to take to build resilience in biosecurity and biodefence systems
- Where deliberate, and if possible, preserve the integrity of the crime scene and collect evidence to prevent further attacks, identify victims, and pursue and prosecute offenders
The report serves as a “multi-sectoral complement” to Africa CDC’s Biosafety and Biosecurity Initiative’s Model Legal Framework. The Initiative was launched in April 2019 to improve outbreak assessment, facilitating appropriate responses. This was pushed forward with the development of a strategic plan (2021-2025), which outlined a coordinated approach to strengthen biosafety and biosecurity. Priority area 6 in the plan seeks to enhance infrastructure, training, and capacity building for the prevention, detection, and response to biological events. The report authors suggest that policies are needed to identify and manage pathogen releases.
Protocols for naturally occurring pathogens
According to the report, African countries do have a “range of protocols, strategies, policies, and systems” to address naturally occurring pathogens. These range from a framework for early detection to epidemic-prone diseases, to the creation of Africa CDC, or the establishment of a One Health programme and coordination group. From the stated protocols and policies, the authors infer:
- Natural outbreaks are those resulting from the transmission and spread of infectious disease in the absence of accidental or deliberate release.
- They can occur because of zoonotic infections, environmental changes, contamination food, water, and environment, or the emergence of new pathogens or re-emergence of agents.
- Understanding the characteristics and patterns of natural outbreaks is crucial for effective response and consequence management.
- Implementing several measures is vital to effectively manage a crisis or outbreak’s economic, social, and political consequences.
Protocols for accidental release of pathogens
Accidental outbreaks have “profound implications” for both public health and law enforcement. Thus, a “systematic approach” is needed. The authors state that there are several “essential factors” to consider. These include “characterising and documenting laboratory accidents and unintended releases and possessing the necessary expertise and technologies for identification and confirmation”.
Effective threat-reduction measures can mitigate the accidental release of pathogens, including:
- Robust biosafety and biosecurity protocols
- Identification of country specific high priority pathogens and conducting risk assessments to check preparedness, response, and mitigation methods
- Adequate training and education
- Simulation exercises
- Robust facility design
- Regular inspections and audits
- Incident reporting and investigation
- Risk assessment and management
- International standards and collaboration
- Research into effective biosafety and biosecurity measures
Implementing these measures can “significantly reduce” the risk of accidental releases.
Protocols for deliberate release of pathogens
Deliberate outbreaks can be caused to “cause harm, instil fear, or disrupt societies”. These can result from:
- Biocrime – threatening to release or using a disease-causing biological agent or toxin to harm or kill an individual or a small group motivated by revenge or the pursuit of monetary gain through extortion or other means.
- Bioterrorism – threats or intentional releases of viruses, bacteria, or other agents or toxins to cause illness or death in people, animals, or plants, driven by ideological, religious, or political beliefs and seeks to create casualties, instil fear, disrupt society, or cause economic losses.
- Biowarfare – using disease-causing agents as weapons, prohibited under the Biological and Toxin Weapon Convention.
“The timely detection and confirmation of deliberate outbreaks requires specialised expertise and advanced technologies within public health and law enforcement.”
The pursuit of next-generation sequencing technologies allows “unprecedented resolution” and “improved understanding” of pathogen transmission dynamics. Other techniques have also been used, and web-based surveillance tools, modelling, and epidemic intelligence methods are “crucial components” for outbreak detection and assessment.
The examples of “consequence management” measures include:
- Public health emergency response
- Medical treatment and isolation
- Contract tracing and quarantine
- Mass vaccination or prophylaxis
- Risk communication and public awareness
- Decontamination and environmental remediation
- Psychological and social support
- Investigation and law enforcement
The measures are “coordinated and multidisciplinary”, with the goal of minimising the effects of deliberate pathogen release outbreaks, protecting public health, and restoring “normal functioning within affected communities”.
WOAH’s algorithm
WOAH proposes an algorithm for handling a suspicious biological event, which can be divided into three main areas of importance:
- Plan
- Assess and respond
- Recover
One Health and multidisciplinary approaches
“Using a One Health strategy, countries should foster collaboration and information sharing among national and regional public health agencies, research institutions, academia, veterinary, agricultural, and environmental services, and international partners.”
This will demand the facilitation of joint investigations and data sharing as well as the establishment of communication channels and platforms for immediate exchange of “information, best practices, and lessons learned”.
Going forward
The brief outlines the importance of an outbreak assessment and consequence management framework to African public health. Such a framework would allow the continent to quickly detect and assess outbreaks, accurately determining their origins, and implementing consequence management pathways in response.
“The increasing threat of accidental and deliberate release of biological agents constitutes a new species of trouble in global health. Governments, public health agencies, and relevant stakeholders must prioritise establishing this framework, allocating necessary resources, and collaborating effectively to ensure its successful implementation.”
What key lessons did you identify in the brief, and how are they relevant to your region if you are not based in Africa? For more discussions on the importance and intricacies of outbreak prevention and management, don’t forget to get your tickets to the Congress in Barcelona next month, and subscribe to our weekly newsletter here.
