An Analysis of International Health Regulations Emergency Committees and Public Health Emergency of International Concern Designations

Nine public health events have been assessed for the potential declaration of a Public Health Emergency of International Concern (PHEIC). According to the World Health Organization (WHO) International Health Regulations (IHR), a PHEIC is defined as an extraordinary event that constitutes a public health risk to other states through international spread and requires a coordinated international response. The WHO Director-General convenes Emergency Committees (ECs) to provide their advice on whether an event constitutes a PHEIC. The EC rationales have been continuously criticised for being non-transparent and contradictory to the IHR. This first comprehensive analysis of EC rationale provides recommendations to increase clarity of EC decisions which will strengthen the IHR and WHO’s legitimacy in future outbreaks. A total of 66 EC statements were reviewed from the nine public health outbreaks of influenza A, Middle East respiratory syndrome coronavirus, polio, Ebola virus disease, Zika, yellow fever and coronavirus disease-2019 (COVID-19). Statements were analysed to determine which of the three IHR criteria were noted as contributing towards the EC’s justification on whether to recommend to the WHO Director-General that a PHEIC be declared and what language was used to explain their decision. Interpretation of the criteria were often vague and applied inconsistently. ECs often failed to describe and justify which criteria had been satisfied. Guidelines must be developed for the standardised interpretation of IHR core criteria. The ECs must clearly identify and justify which criteria have contributed to their rationale for or against PHEIC declaration. Striving for more consistency and transparency in EC justifications would benefit future deliberations and provide more understanding and support for the process

U.S.-Singapore-Malaysia-Indonesia Multilateral Dialogue on Biosecurity: Year 2

Performer: University of Pennsylvania Medical Center (UPMC) Center for Health Security Project Lead: Anita Cicero Project Cost: $223,784 FY16–17This follow-on project will comprise two biosecurity dialogues among the United States, Singapore, Malaysia, and Indonesia to address regional risks related to deliberate or accidental misuse of biological materials, biosecurity and biosafety vulnerabilities at high-containment laboratories, security issues posed by dual-use science, and infectious disease outbreaks that might pose security threats. Countries in Southeast Asia are particularly vulnerable to biosecurity threats due to the region’s dense population, high volume of cross-border traffic, and frequent, closequarter co-location of humans and animals. For these reasons, Southeast Asia is susceptible to emerging and re-emerging diseases (e.g., SARS, H5N1, Nipah virus). Bioscience labs are also becoming more common in the region, and “viral sovereignty” continues to be an issue. Moreover, there are known terrorist networks active in the area.PASC

Singapore - US Strategic Dialogue on Biosecurity

PASCC ReportSingapore is a critical security partner to the US in Southeast Asia. The US and Singapore share long-standing military relations, with American forces making use of Singapore’s Naval Base facilities, contributing to peace and stabilizing efforts throughout the region, offering humanitarian assistance, and acting as a deterrent to potential security threats.1 US-Singaporean security cooperation also extends to bilateral exercises, joint military training activities, and cargo screening efforts. The importance of Singapore to biosecurity in Southeast Asia continues to grow, due to its rapid biotechnology growth, its leadership in biosafety training within the region, its experience in containing the pandemic of severe acute respiratory syndrome (SARS), as well as ongoing preparedness efforts related to new, emerging diseases.This publication results from research supported by the Naval Postgraduate School’s Project on Advanced Systems and Concepts for Countering Weapons of Mass Destruction (PASCC) via Assistance Grant/Agreement No. N00244-14-1-0040 awarded by the NAVSUP Fleet Logistics Center San Diego (NAVSUP FLC San Diego). Project on Advanced Systems and Concepts for Countering Weapons of Mass Destruction, Naval Postgraduate School, Defense Threat Reduction Agenc

U.S.-Singapore-Malaysia-Indonesia: Multilateral Dialogue on Biosecurity

Performer: University of Pittsburgh Medical Center, Center for Health Security Project Lead: Anita Cicero Project Cost: $235,000 FY15-16Objective: Countries in Southeast Asia are particularly vulnerable to biosecurity threats due to the region’s dense population, high volume of cross-border traffic, and frequent, close-quarter co-location of humans and animals. For these reasons, Southeast Asia is susceptible to re-emerging and emerging diseases (e.g., SARS, H5N1, Nipah virus). Bioscience labs are also becoming more common in the region, and “viral sovereignty” continues to be an issue. Moreover, there are known terrorist networks active in the area. This project seeks to initiate sustainable and productive dialogue among the United States, Singapore, Malaysia, and Indonesia on sensitive issues pertaining to deliberate, accidental, and naturally occurring biothreats, dualuse science, and infectious disease outbreaks. The dialogue will help promote habits of trust and collaboration within a region where there is limited agreement on how to navigate the challenges of sharing essential public health information. It will not only strengthen each nation’s ability to identify and respond to biothreats, but also help practitioners and policy makers identify effective practices to diminish risks posed by these threats to international security.PASC

Strategic Multilateral Dialogue on Biosecurity

Project on Advanced Systems and Concepts for Countering Weapons of Mass Destruction (PASCC) Naval Postgraduate School Defense Threat Reduction Agenc

Southeast Asia Strategic Multilateral Dialogue on Biosecurity

A strategic multilateral dialogue related to biosecurity risks in Southeast Asia, established in 2014, now includes participants from Singapore, Malaysia, Indonesia, Thailand, Philippines, and the United States. This dialogue is conducted at the nonministerial level, enabling participants to engage without the constraints of operating in their official capacities. Participants reflect on mechanisms to detect, mitigate, and respond to biosecurity risks and highlight biosecurity issues for national leadership. Participants have also identified factors to improve regional and global biosecurity, including improved engagement and collaboration across relevant ministries and agencies, sustainable funding for biosecurity programs, enhanced information sharing for communicable diseases, and increased engagement in international biosecurity forums

Potentiation of antibiotic activity by Passiflora cincinnata Mast. front of strains Staphylococcus aureus and Escherichia coli

The development of new drugs from plants is an interesting alternative approach to overcoming microbial resistance. Passiflora cincinnata shows resistance to diseases and pests and a higher concentration of chemical components that may be useful in the pharmaceutical industry. We investigated the potential antimicrobial and antibiotic-modifying activity of hydroalcoholic extracts of leaves, stems, bark, pulp and seeds of P. cincinnata. The extracts were prepared by homogenization of material in 50% ethanol. Minimum inhibitory concentration (MIC) was determined by the broth dilution method, and the bacterial strains tested were Staphylococcus aureus and Escherichia coli. Antibiotic-modifying activity was evaluated against the strains S. aureus 03 and E. coli 08, using a subinhibitory concentration of extract. The antibiotics tested were: amikacin, gentamicin, ampicillin, potassium benzylpenicillin and oxacillin. The extracts did not show antimicrobial activity of clinical relevance, where the MIC was equal to or greater than 1024 μg/mL. S. aureus showed 13 events, while E. coli showed only 4 events. Among these events, 14 involved synergistic activity, potentiating the effect of the antibiotics, and only 3 events demonstrated antagonistic activity toward ampicillin. Hydroalcoholic extracts are potential antimicrobial agents when combined with conventional drugs little utilized in in vivo treatment