Forum on Microbial Threats: 2019 Annual Report (2020)

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FORUM ON MICROBIAL THREATS 2019 Annual Report Health and Medicine Division nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 | 202.334.2000 

2019 Publications The Convergence of Infectious Diseases and Noncommunicable Diseases: Proceedings of a Workshop Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 | 202.334.2000 

Forum on Microbial Threats 3 Message from the Chairs The last decade saw the re-emergence of old diseases such as cholera and the emer- gence of new diseases such as Zika virus, Middle East Respiratory Syndrome (MERS), and the 2019 coronavirus (COVID-19). This new decade will likely see a continua- tion of these patterns, further complicated by the effects of climate change. When a pathogen emerges or reemerges, it can have broader and more severe conse- quences on our health, our economies, and our security in this modified and highly connected world. The way we respond to outbreaks, the way we conduct research, our policies and regulations, and the drugs and vaccines to combat diseases must be innovative and forward thinking in order to address the growing complexity of microbial threats. The Forum on Microbial Threats, with its diverse group of leaders from academia, government agencies, the private sector, and public society, creates a platform for cross-disciplinary, flexible, and creative thinking that can anticipate and be responsive to constantly evolving microbes in a rapidly changing planet. Peter Daszak, Ph.D. Forum Chair Since the Forum on Microbial Threats was formed in 1996, it has provided a struc- tured opportunity for leaders from a wide range of disciplines and industries to debate the most effective ways to understand, anticipate, and “manage” emerging infectious diseases. From plant health and food security to the convergence of in- fectious disease and noncommunicable diseases, Forum activities have gradually coalesced around key themes: a cross-disciplinary One Health approach that brings together our understanding of human, animal, plant, and environmental health; a readiness to work on the full infectious disease landscape that includes the impact on global health security and economies; and a commitment to serving our nation by focusing on improvements to clinical medicine, public health, policy, and the in- adequate antimicrobial and vaccine pipeline. In 2019, the Forum continued its evolution. We expanded and diversified our spon- sors and membership to better reflect the diversity of global microbial threats. This Mary E. Wilson, M.D. included representation from institutions working on neglected tropical diseases, child health, and global and state-focused public health. We held the workshops Forum Vice-Chair “Breaking Down Silos: The Convergence of Infectious Diseases and Noncommu- (through December 2019) nicable Diseases” and “Exploring the Frontiers of Innovation to Tackle Microbial Threats.” We worked closely with the One Health Action Collaborative (OHAC) to continuously accentuate the value of the One Health approach in disease outbreaks. Throughout these activities, our discussions helped champion a growing approach to infectious agents that is both multidisciplinary and “big picture,” but remains rele- vant to public health and medicine. As we move into 2020, the Forum’s leadership remains committed to confronting the challenge of evolving microbial threats and addressing barriers to accessing and utilizing therapies. The plans include a workshop assessing and addressing vaccine access and hesitancy globally, and activities that highlight the One Health approach in response and preparedness efforts. The Forum recognizes that poor vaccine cov- erage in many populations globally has underlying political and socio-cultural fac- tors and that effective community engagement is essential in addressing microbial threats. We look forward to helping identify new strategies to bolster confidence Kent E. Kester, M.D. and trust in science, and new ways to engage with communities to bolster global Forum Vice-Chair health security in a connected world. nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 3 Reflecting Back: Forum Activities in 2019 Since 1996, the Forum has been committed to provid- “The panel Alan [Tennenberg] moderat- ing a structured opportunity for discussion and scrutiny ed was the most robust discussion I have of critical, and possibly contentious, issues related to seen in a meeting in a while.” research on microbial threats. Forum meetings con- vene domestic and international experts and leaders in the infectious disease field to explore complex issues —Forum member and workshop attendee, and work toward a shared understanding. In 2019, the Exploring the Frontiers of Innovation to forum held two workshops, two closed meetings, and Tackle Microbial Threats published two Proceedings of a Workshop that covered a variety of topics and issues, including the synergy between communicable and noncommunicable diseases, social and technological innovations tackling microbial threats, and drawing from lessons learned from a century of outbreaks to sufficiently prepare for future pandemics. June 11-12: Breaking Down Silos: The Convergence of Infectious Diseases and Noncommunicable Diseases – A Workshop | New York Available: Archived videos | Proceedings Chaired by Forum chair Peter Daszak (EcoHealth Alliance) with opening remarks by Naveen Rao (The Rocke- feller Foundation), this workshop convened more than 100 domestic and international stakeholders with ex- pertise in infectious diseases and noncommunicable diseases, specifically, in the growing interconnectedness of infectious and noncommunicable diseases. Workshop participants discussed the relationship between micro-organisms and chronic diseases, explored innovative integrated approaches to responding to the dual burden of the convergence of infectious diseases and noncommunicable diseases, and shared strategies to break down silos and advance the research agenda for the convergence of infectious diseases and non- communicable diseases. The proceedings of the workshop has been downloaded over 1,600 times in 100 countries within three months. December 4-5: Exploring the Frontiers of Innovation to Tackle Microbial Threats A Workshop | Washington, DC Available: Archived videos | Proceedings to be released by August 2020 Co-chaired by Forum members Kent Kester (Sanofi Pasteur) and Rafael Obregón (UNICEF), this workshop assembled a diverse group of stakeholders from multilateral organizations, national governments, private sector, and civil society that examined the major “The core issue remains…[it’s] not really vaccines advancements in social, technological, and scien- but vaccination. No matter how good a vaccine is, tific innovations to tackle microbial threats. From as long as they are inside those vaccine vials they partnerships to metagenomics, workshop partic- ipants discussed novel approaches to preparing are probably zero percent effective...” for, and responding to infectious diseases. —Workshop presenter, Exploring the Frontiers of Innovation to Tackle Microbial Threats nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 4 Looking Forward: Forum Activities in 2020 The Forum continually identifies priority topics to convene public workshops several times per year, with the goals of influencing new ways of thinking, fostering cross-sectoral collaborations and new profes- sional relationships, and inspiring research and action to shape the field of infectious diseases. Further- ing the conversations in 2019, the Forum will hold workshops in 2020 that address current and emerging issues in infectious diseases with global health consequences, focusing on the public health value of vaccines and preparedness and response efforts for infectious disease outbreaks. August 19-20: The Critical Public Health Value of Vaccines – Tackling Issues of Access and Hesitancy – A Workshop | Washington, DC A planning committee of the National Academies of Sciences, Engineering, and Medicine will organize a workshop series to examine the current state of vaccine preventable diseases and the impact of vaccine access and hesitancy globally, and the multidimensional drivers and impacts of declining vaccine con- fidence. The in-person workshop will explore health systems, research opportunities, communication strategies, and policies that could be considered to address access, perceptions, attitudes, and behav- iors toward vaccination. The planning committee will also organize a 2-hour virtual meeting. The virtual meeting will serve as a teaser to pique public interest in the topic and increase the reach of the in-person workshop in late summer. The workshop series will feature invited presentations and discussions on the following topics: • The global impact of declining immunization rates on vaccine-preventable diseases from lack of access and confidence; • Trends and indicators to monitor attitudes surrounding vaccine safety and efficacy, including a focus on regional and cultural differences; • The complex determinants of vaccination that hinder or promote vaccine uptake; • The role of health systems and professionals in improving access, influencing vaccine behavior, pro- tecting at-risk communities from vaccine-preventable disease outbreaks, and preserving and build- ing confidence in immunization strategies and practices; • The role of media, anti-vaccine networks, and online misinformation in reinforcing anxieties about vaccine safety and drivers of vaccine hesitancy; • Strategies to enhance community-based approaches and community engagement efforts for im- proving access and reducing vaccine hesitancy; • Communication approaches that would help assuage anxieties about vaccine safety and strengthen public trust in science and health professionals; • The ethics and effectiveness of legislation that aim to address vaccine hesitancy; and • Potential priority actions as well as partnerships and collaborations among policy makers, health professionals, national and international health organizations, parents, and community groups to increase immunization access and vaccine confidence. Speakers and discussants will contribute perspectives from government, academia, private, and non- profit sectors. The planning committee will organize the workshop series, select and invite speakers and discussants, and moderate the discussions. A proceedings of the presentations and discussions will be prepared by a designated rapporteur in accordance with institutional guidelines. December 7-8: Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks Stay tuned for more information on this workshop! nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 5 One Health Action Collaborative The One Health Action Collaborative (OHAC) associated with the Forum is an opportunity to engage a community of participants who are interested in collectively exploring the current status, successes, and challenges of deploying the One Health approach and to catalyze efficient and effective implementation. Chaired by forum member Jonna Mazet (University of California, Davis), OHAC is comprised of both forum members and stake- holders external to the forum. Through ongoing dialogue and information sharing, OHAC’s objectives are to: • Discuss the current understanding of high-risk interfaces for patho- gen spillover from animals into people; • Review best practices and valuable lessons in integrating the One Health approach in outbreak preparedness and response; • Develop ideas for expanding and linking One Health efforts to plant and environmental health; Jonna A. K. Mazet, Ph.D., D.V.M., M.P.V.M. • Identify priorities, effective strategies, and creative solutions for preventing and controlling emerging disease threats; and OHAC Chair • Inspire policy decisions and encourage global and local health ca- pacity investments that would advance One Health efforts. The work of the action collaborative does not necessarily represent the views of any one organization, the forum, or the National Academies and is not subjected to the review procedures of, nor are they a publication or product of, the National Academies. nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 5 Upcoming at OHAC in 2020 World One Health Congress In a joint effort, OHAC and the USAID One Health Workforce – Next Generation will hold a side event at the 2020 World One Health Congress that will gather in- ternational experts across the One Health domains to articulate the successes of the One Health approach over the years and to discuss a pathway forward for the future of One Health, outlining work- force-strengthening priorities that will en- sure our ability to prevent and respond to global health threats. nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Activities and Future Directions 6 Action Collaborative Members (through December 31, 2019) Jonna A. K. Mazet, Ph.D., D.V.M., M.P.V.M. (Chair) University of California, Davis Kevin Anderson, Ph.D. U.S. Department of Homeland Security Casey Barton Behravesh, D.V.M., Dr.P.H., M.S. U.S. Centers for Disease Control and Prevention Peter Daszak, Ph.D. EcoHealth Alliance Gail R. Hansen, D.V.M., M.P.H. Hansen Consulting, LLC Elizabeth D. Hermsen, Pharm.D., M.B.A. Merck & Co., Inc James M. Hughes, M.D. Emory University Maureen Lichtveld, M.D., M.P.H.* Tulane University Sally A. Miller, Ph.D. The Ohio State University Elizabeth Mumford, D.V.M., M.S. ** World Health Organization Amy Pruden, Ph.D.* Virginia Tech David M. Rizzo, Ph.D. University of California, Davis Jonathan Rushton, Ph.D., M.A., M.AgSci.* University of Liverpool Mary E. Wilson, M.D. University of California, San Francisco -- *New members in 2019 * Views and opinions expressed by Mumford are her own and do not necessarily reflect the view of the World Health Organization. nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 7 Ongoing OHAC Deliverables One Health Workers Complementing the core competencies in One Health education publication, OHAC members de- veloped a survey designed to shed light on the use- fulness and benefits of a One Health education and the potentially unique challenges that One Health workers face. The objectives were to characterize students, graduates, workers, and employers in the One Health arena; understand the benefits of One Health education; elucidate unique challenges that One Health workers face; and assess whether em- ployers are satisfied with the skillsets of employees who have received training in the One Health arena. The survey was disseminated to over 500 stakehold- ers worldwide. In the past year, OHAC members have completed analyzing results from the online survey. The findings and recommendations will be present- ed in two manuscripts which are currently under way. Plant Health and Food Security Recognizing the importance of elevating the role of plant health in the One Health approach, OHAC members are developing a deliverable that high- lights the complex interaction between humans, plants, and animals. Specifically, this deliverable aims to raise awareness among human and animal health professionals on the impact of plant health on food security through four illustrative case studies and help elevate the United Nations International Year of Plant Health in 2020. OHAC members are complet- ing a final draft of the white paper and will submit the paper to a peer-reviewed journal in early 2020. One Health at the State and Local Levels OHAC members have discussed a potential new deliverable on implementing and operationalizing One Health on the state and local levels. The aim of this deliverable is to fill the gap in resources and guidance for state and local agencies, including non-governmental agencies to operationalize and implement One Health policies. The deliverable will involve developing proof of concept and providing an operational framework for these organizations to use when considering, developing, and evaluating their respective One Health policies and strategies. nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Activities and Future Directions 8 Sponsors (through December 31, 2019) The Forum membership strives to be reflective of the diversity of microbial threats and the multi- disciplinary, cross-sectoral collaboration necessary to address emerging challenges. Sponsors and members of the Forum include a range of stakeholders from government agencies, pharmaceuti- cal industry, nonprofit associations, and academia across human, animal, and plant health. Biomedical Advanced Research and Development Authority U.S. Agency for International Development U.S. Centers for Disease Control and Prevention U.S. Department of Homeland Security U.S. Department of Veterans Affairs U.S. Food and Drug Administration U.S. National Institutes of Health Uniformed Services University of the Health Sciences American Society of Tropical Medicine and Hygiene* EcoHealth Alliance Infectious Diseases Society of America Johnson & Johnson Merck & Co., Inc. Sanofi Pasteur *New sponsor in 2019 nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 9 Members (through December 31, 2019) Peter Daszak, Ph.D. (Chair) Jonna A. K. Mazet, D.V.M., M.P.V.M., Ph.D. EcoHealth Alliance University of California, Davis Mary E. Wilson, M.D. (Vice Chair) Sally A. Miller, Ph.D. University of California, San Francisco The Ohio State University Kent E. Kester, M.D. (Vice Chair) Suerie Moon, Ph.D., M.P.A. Sanofi Pasteur The Graduate Institute, Geneva Kevin Anderson, Ph.D. David Nabarro, B.M.B.Ch., MFPHM, FRCP U.S. Department of Homeland Security 4SD – Skills, Systems & Synergies for Sustainable Development Timothy Burgess, M.D., M.P.H. Uniformed Services University of Health Sciences Rafael Obregon, Ph.D., M.A. United Nations Children’s Fund Rick Bright, Ph.D. Biomedical Advanced Research and Development Authority Kumanan Rasanathan, M.B.Ch.B., M.P.H. Health Systems Global Cristina Cassetti, Ph.D.* National Institute of Allergy and Infectious Diseases Gary A. Roselle, M.D. U.S. Department of Veterans Affairs Andrew Clements, Ph.D. U.S. Agency for International Development Peter A. Sands, M.P.A. The Global Fund to Fight AIDS, Tuberculosis & Marcos A. Espinal, M.D., Dr.P.H., M.P.H. Malaria Pan American Health Organization Thomas W. Scott, Ph.D. Keiji Fukuda, M.D., M.P.H. University of California, Davis University of Hong Kong School of Public Health Jay P. Siegel, M.D. Eva Harris, Ph.D. Retired At-Large Member University of California, Berkeley Alan Tennenberg, M.D., M.P.H. Elizabeth D. Hermsen, Pharm.D., M.B.A. Johnson & Johnson Merck & Co., Inc. Matthew Zahn, M.D. Chandy C. John, M.D., M.S.* Orange County Health Care Agency American Society of Tropical Medicine and Hygiene Rima F. Khabbaz, M.D. U.S. Centers for Disease Control and Prevention Michael Mair, M.P.H. U.S. Food and Drug Administration *New member in 2019 nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

Forum on Microbial Threats 9 About the Forum The Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine was cre- ated in 1996 at the request of the U.S. Centers for Disease Control and Prevention and the National Institutes of Health to provide a structured opportunity for discussion and scrutiny of critical, and possibly contentious, scientific and policy issues related to research on and the prevention, detection, surveillance, and responses to emerging and reemerging infectious diseases in humans, plants and animals as well as the microbiome in health and disease. The Forum brings together leaders from government agencies, industry, academia, and nonprofit and philanthropic organizations to facilitate cross-sector dialogue and collaboration through public debate and private consultation to stimulate original thinking about the most pressing issues across the spectrum of microbial threats. Despite decades of progress, the need for the Forum on Microbial Threats remains. Problems such as MERS, Ebola, Chikungunya, Zika, yellow fever, and antibiotic resistance demonstrate how the issue of emerging infections is global and unrelenting. The drivers are ever more pervasive, and the consequences—human, social, and economic—loom larger than ever. The Forum convenes several times each year to identify and discuss key problems and strategies in the area of microbial threats. To supplement the perspectives and expertise of its members, the Forum also holds public workshops to engage a wide range of experts, members of the public, and the policy community. All workshops are summarized in high quality scholarly workshop proceedings that are available for free down- load from the National Academies Press. The Forum on Microbial Threats is part of the National Academies’ Board on Global Health. For more infor- mation about the Forum, please visit our website: www.nationalacademies.org/microbialthreats. Forum Staff Julie Pavlin, M.D., Ph.D., M.P.H. Director, Forum on Microbial Threats (from December 2019) Director, Board on Global Health Cecilia Mundaca Shah, M.D., Dr.P.H. Forum Director (until December 2019) V. Ayano Ogawa, S.M. Senior Program Officer (until December 2019) Edith Amponsah, M.P.H. Associate Program Officer (from August 2019) Stephen Chukwurah Senior Program Assistant (August 2019 – December 2019) Hannah Goodtree Senior Program Assistant (from November 2019) nationalacademies.org/microbialthreats | 500 Fifth Street, NW | Washington, DC 20001 

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