The American Preparedness Plan includes one section and $2.0B on preventing accidental and deliberate pandemics. That’s… not much given the $$$trillion cost of (comparatively mild) SARS-CoV-2 and the $714 billion Pentagon budget. 1/20
First, the elephant in the room: there currently isn’t enough evidence to determine the origin of SARS-CoV-2. It’s widely acknowledged that the pandemic might have arisen from a natural spillover, a virus hunter getting infected, or a lab escape. 2/
If we agree COVID-19 arose from either spillover or lab escape, then lab-caused pandemics must be 1) plausible, and 2) able to kill more Americans than died in combat in all wars combined. Perhaps we should take this seriously. 3/
en.wikipedia.org/wiki/United_St…
10. Biosafety, Biosecurity, and Reducing Catastrophic Biothreats: $2.0B. Prevent lab accidents and deter bioweapons development by expanding our ability to identify security risks in biotech. Share globally. 4/
+ Engineered pandemics could be especially lethal; best stop them from existing
+ Encourage new tech to safeguard biotechnology
+ Ensure R&D doesn’t spark accidental pandemics
+ Deter/detect bioweapons development through norms, detection, & attribution 5/
+ How to go about threat identification is super vague
- Implies we’ll do R&D on things that could cause pandemics - bad idea!
- Will we fund the Biological Weapons Convention, which recently had just 4 full-time staff? 6/
It’s the first point that gets me. If we think future pandemics could be lab-caused and much more lethal than SARS-CoV-2 (trivially true), then why is a one-time biodefense investment of <10% of the Pentagon’s annual budget considered a reach? 7/
But okay, political realities. This plan alone moves the Overton window in the direction of actual preparedness that utilizes modern capabilities. I’m deeply grateful. So, what does it actually do? 8/
Presumably threat detection & deterrence refers to nascent platforms like SecureDNA, which can automatically screen DNA synthesis orders for hazards without disclosing either. If so, great. 9/
secureDNA.org
Caveat: international programs like SecureDNA can’t always accept government funding: taking it from one government means the project will be mistrusted by others. We need everyone on board. So this is tricky. 10/
Genetic attribution is another path to deterrence that we and others have been advancing. To work, attribution must be credible and well-known; these funds could help. 11/
nature.com/articles/s4146…
pubmed.ncbi.nlm.nih.gov/33293535/
drivendata.co/blog/genetic-e…
Early-warning via sequencing is plausibly the best deterrence of all. Few will bother building a nasty bioweapon if it’ll be swiftly & reliably detected by metagenomic sequencing of the environment and airport wastewater. 12/
arxiv.org/abs/2108.02678
The biggest challenge: how can we identify research that is net harmful to security risks and halt it without highlighting those risks for malevolent actors? Al Qaeda only pursued bioweapons due to public US govt alarm over their potential. 13/
Even halting dangerous research may be beyond us. There are funds for “biosafety” in pandemic preparedness, implying we’ll continue research to make potential pandemic pathogens more transmissible. 14/ washingtonpost.com/nation/interac…
Another major risk: potential pandemic virus discovery and characterization is also funded by the US government and other nations. What are the criteria for deciding it’s too risky? Who gets a say? A vote? This concerns all of us. 15/
Irrespective of accidents, pandemic virus research is a security nightmare. Discover an agent that would credibly cause a pandemic from natural spillover, publicize it to reduce that risk, and you just told everyone how to deliberately cause a pandemic. 15/
I suspect this is political. Security isn’t NIH’s job. They support biomedical research. Biomedicine can’t help without knowing the nature of the threat, so they want to figure out what it might be. The writers of the APP plan can't change this. 16/
On the upside, more support for intelligence agencies to search for potential weapons programs and the State Dept apply diplomatic leverage could be very helpful. The Biological Weapons Convention is clear; give it teeth. 17/
en.wikipedia.org/wiki/Biologica…
Overall, I’m grateful that there is an emerging focus on biosecurity, but I’m concerned because it’s clear that we will continue to fund efforts to credibly identify or create viruses capable of causing new pandemics. 18/
Nation-states and defense establishments need to wake up. Accessible pandemic-class agents are not in the interests of any organized society. We need a pandemic nonproliferation movement, and we need it yesterday. 19/
Next up: Containing an epidemic before it becomes a pandemic is incredibly difficult; competent institutions are vital. So what to do about their across-the-board failure to deal with the SARS-CoV-2 pandemic? 20/20
Last thread evaluating the American Pandemic Preparedness plan: institutional reforms, a final grade, what's missing, and where to go from here:

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More from @kesvelt

16 Sep
Let’s not fool ourselves. Containing an epidemic before it becomes a pandemic is difficult.

But CDC and FDA failed us. Their incentives aren’t suited to emergencies; politics made it worse. Lots of people died. The White House plan includes reforms. 1/20
@kmvnarayan14, Curran, Foege, and many others have suggested solutions, including a politics-resistant Federal Reserve model for pandemic preparedness and an independent advisory board to call out failures in real-time. 2/
jamanetwork.com/journals/jama/…
I’d go further: in a pandemic emergency, new leaders incentivized to act fast and at scale should take over. You don’t run clinical trials in a 30% lethality pandemic; you get shots into arms as they’re developed and track what happens. 3/
Read 19 tweets
14 Sep
Interested in preventing future pandemics? SecureDNA, an int’l academic/commercial project, seeks a development manager (+Rust & Python coders soon) to prevent the unauthorized synthesis of pandemic viruses & bioweapons. 1/7
securedna.org/jobs
Today, it’s all too easy to make nasty things from synthetic DNA, as only members of the International Gene Synthesis consortium (~80% of all DNA) voluntarily check orders for hazards. It’s expensive and requires human experts. 2/7
genesynthesisconsortium.org
If someone were to disclose how to make a new pandemic virus, anyone with the relevant lab skills could follow reverse genetics protocols, order it from synthetic DNA, and assemble it. That’s far too many people. 3/7
Read 7 tweets
14 Sep
We need early warning to detect epidemics before they grow into pandemics, public health to lead the response, and protective equipment to reduce baseline transmission. For this last, the American Pandemic Preparedness plan includes $5.2B. 1/18
IV Building Core Capabilities

8. Personal Protective Equipment: $3.1B. Develop better protective gear for the next pandemic and update buildings to block transmission. 2/
+ N95s are imperfect, uncomfortable, and ugly: we need reliable, comfortable, and fashionable
+ Easy to manufacture is key to making enough for everyone
+ Respiratory is the big one, but worth blocking surface transmission too 3/
Read 19 tweets
13 Sep
Early detection and pandemic monitoring systems will warn us of new threats and track spread, but containment will be up to public health. The American Pandemic Preparedness plan tries to ensure that it’ll be up to the challenge. 1/
If a pandemic is like a forest fire, pharmaceutical treatments are the chemical fire suppressants, while public health measures the prophylactic firebreaks, controlled burns, brush-clearing, etc that keep it from spreading 2/
Unlike a forest fire, medical countermeasures take time to develop (if possible at all), so prophylaxis is doubly important. Tiny brushfires are easily controlled, massive infernos not so much. Speed is crucial. 3/
Read 21 tweets
6 Aug
I'm deeply worried about future pandemics & nastier agents. Nature doesn’t try to kill us; humans will. This e-print details a universal early-warning system: a “Nucleic Acid Observatory” (#NAO).
arxiv.org/abs/2108.0267
1/20
All catastrophic bio-threats grow exponentially
All bio is made of nucleic acids
To detect all threats, deep sequence wastewater + rivers & look for exponentially growing fragments (k-mers)
arxiv.org/abs/2108.02678
#NAO
2/20
Why a Nucleic Acid Observatory? @EricLander46: “to keep future viruses from becoming pandemics… (we need) early-warning systems to spot new biological threats anywhere in the world soon after they emerge” washingtonpost.com/opinions/2021/…
3/20
Read 21 tweets
11 May 20
Can tracing alone control COVID?

Our model: it's possible if we >double efficacy by changing how we trace & use digital apps.

Thanks to @willbradbio, @EthanAlley, @jhhhuggins, & epidemiologist @alun_l !

doi.org/10.1101/2020.0…

1/n
Tl;dr: We need bidirectional tracing to find infectors and undiagnosed carriers, and almost everyone’s smartphones should “chirp”. Combined = we win… in the optimistic scenario. Else add masks or distancing.

2/n
Right now, we “forward-trace” to find and isolate people who were exposed so they don’t infect anyone else.
Problem: many cases are undiagnosed, especially if asymptomatic, so we miss branches of the viral family tree.

3/n
Read 21 tweets

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