Dr Alexandra Phelan Profile picture
Asst Professor @Georgetown_GHSS | Adj Prof @GeorgetownLaw | Pandemics, Infectious Disease, International Law, Planetary Health, Human Rights 余雪莲 She/Her 🏳️‍🌈
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20 Feb
Unofficial reports so far state that the subtype is H5N8 – this would be a novel influenza subtype in humans.

The IHR require immediate reporting of *any* novel human influenza subtypes as potential PHEICs, no matter how serious.
Since 2020, there has been a global H5N8 outbreak among bird populations – wild birds and poultry. Cases have been reported in Saudi Arabia, Russia, Kazakhstan, Netherlands, Germany, Denmark, UK, France, Sweden, India, Japan, Norway, South Korea.

e.g. Estonia's 17 Feb OIE report
We may have just seen the leap occur from animals to humans here because of the nature of the human/animal interactions in this poultry farm, or there may be something genetically distinct. We need sequencing to know this.
Read 6 tweets
20 Feb
Russian has reported seven human cases of avian influenza to @WHO

No confirmation of subtype yet.

No evidence yet of human to human transmission: all cases reported are workers in a poultry plant.

There have been a few highly pathogenic avian influenza infections (HPAI) across Europe recently in wild birds (@OIEAnimalHealth – WAHIS appears to be down this morning?)
Under the International Health Regulations (2005), countries must report any cases of a novel influenza subtype in humans as a potential PHEIC.

This is the first cluster in humans of an HPAI in Europe reported this year. It is not yet up on WHO DONs or promed.
Read 9 tweets
29 Jan
*Public health actions to control new SARS-CoV-2 variants*

Our paper just published in @CellCellPress w wonderful co-authors @NathanGrubaugh @firefoxx66 @JosephFauver & @mugecevik

We describe actions govts should urgently take to protect health.


New SARS-CoV-2 variants of concern will continue to emerge: exacerbating already crippling outbreaks & potentially reducing efficacy of some vaccines, cause increased rates of reinfections and prolonging the pandemic.

As SARS-Cov-2 variants of concern to date have shown: these are global issues. There must be urgent multilateral cooperation between countries to:
– build local sequencing capacities
– rapidly share sequence data globally
*and separately*

Read 7 tweets
29 Jan
Today, @ThinkGlobalHlth is celebrating its one year anniversary. @RebeccaKatz5 & I were fortunate enough to be invited to write a piece for this new @CFR_org blog, led by @TomBollyky.

Some reflections from that piece on why global governance matters.
From the outset, it was obvious that global governance was about to be seriously tested. Unfortunately, over this pandemic we've seen that play out to be the case – not only globally but also national governance.
There was a huge risk that WHO would be sidelined because states rejected WHO advice (for a range of reasons), but also because it has been woefully underfunded for years.
Read 6 tweets
22 Dec 20
I disagree with folks dismissing the implications of the UK variant of concern.

While individual behaviors to avoid transmission may not change, the impact at the population level is serious: hospitals are already at capacity.

Quick thread
Any factor that ramps up transmission (biological or behavioral) amplifies cases, and as a result, severe cases and deaths. When hospitals hit capacity, cases that could have been treated successfully will be triaged along increasingly stringent crisis standards of care.
At the population level, this also impacts government responses about control measures, which impacts now & future justifications
Short thread on that here:

Read 6 tweets
21 Dec 20
Public Health England has just released their updated report on the UK #SARSCoV2 variant

"Investigation of novel SARS-CoV-2 variant: Variant of Concern 202012/01"

I'll do a quick summary thread below & link to report:
A cluster was identified & used to assess increasing incidence of the Variant of Concern (designated as such 18 Dec) in Kent, UK:
- 4% (255/6130) of Kent cases had available genomes
- in Kent: 117 genomically similar cases identified (10-19 Nov)
- in UK: 962 genomes of VoC(8 Dec)
Out of that 962 UK wide, epi data was available for 915 individuals.

As of 20 Dec, VoC present mainly in London, South East & East of England regions.

The report goes into the details of how the VoC testing is carried out.
Read 8 tweets
20 Dec 20
A lot of good discussion today about what we know and don't know about the new #SARSCoV2 variant in the UK.

But what does this mean (if anything) for government responses & public health law control measures, even if greater transmissibility is confirmed?

Quick notes (1/7)
Firstly, the virus is already sufficiently transmissible to be a concern. As others have noted, already important critical public health measures (avoiding crowds, social distancing, mask wearing, hand washing) will address variants that emerge:
First "but": any potential increase in transmissibility might shift how we weigh the stringency or priority of certain interventions, and how justifications for public health laws determine what is "the least restrictive measure".
Read 7 tweets
10 Dec 20
Vaccine news that may not be covered outside of Australia:

The University of Queensland/CSL #covid19 vaccine trial has reportedly been abandoned for really interesting reasons, with one less potential vaccine for global COVAX Facility pool.

Quick thread:
The UQ/CSL vaccine (V451) uses a molecular clamp vaccine platform with the COVID-19 spike protein: the clamp "locks" the spike protein to be more stable for purification & manufacture. It contains a small component derived from HIV that cannot infect people & poses no health risk
However, this component resulted in some participants (out of 200 volunteers inc. placebo & vaccine) in Phase 1 trial producing "a partial antibody response" which interfered with HIV screening tests (which detect HIV antibodies, not virus) resulting in false positive HIV tests.
Read 5 tweets
9 Dec 20
With the vaccine Executive Order now up, President Trump has ordered that "Americans" have priority to "US Govt COVDI19 Vaccines".

I want to push back on some arguments dismissing the risk of this as there are very concerning impacts.

United States Government COVID-19 Vaccines are defined in the EO as "COVID-19 vaccines developed in the United States or procured by the United States Government"

This does not limit the scope of the EO to those purchased under APAs, but includes vaccines developed here.
That said, implementation of EO will likely start w vaccines purchased by US Govt under APAs. This alone is concerning:

US govt has bought signif. number of global mRNA vaccines:
– Moderna: 100m doses/266m in APAs + 400m option
– Pfizer: 100m doses/590m in APAs + 500m option
Read 6 tweets
1 Dec 20
This is a huge drop of China #COVID19 documents from @npwcnn. Unfortunately, this leak confirms points I & other China, health, law folks have said since Jan.

I'm going to summarize some of the key findings in 🧵below

Here's full report:
Finding 1: Hubei (Wuhan's province) had 20 times increase in "influenza cases" in Dec. High number of "unknown cause" is flag: flu relatively easy to confirm if tested. Also not clear how many confirmed influenza, & if so, if/what samples or GSD was shared w @WHO GISRS.
Finding 2: signif underreporting of daily new cases & deaths in Feb & Mar. If you recall, this was a live issue at that time w reclassification of case definitions by Chinese health officials, but report indicates deliberate politicization of data to present optimism.
Read 10 tweets
29 Nov 20
Lovely piece from @guardian on our recent publication in Proc @royalsociety B "What would it take to describe the global diversity of parasites?"

It may not be apparent but this is also a story of rectifying colonial "exploration narratives".


To follow the article, here's a great explainer thread about our piece by @wormmaps about the science of estimating how many uncounted parasites there may be (including the Brothers Grimm & uncountable things):


https ://twitter.com/wormmaps/status/1329070889372176384?s=20
In the @guardian piece, I love this quote about entire unknown worlds:

Read 7 tweets
15 Nov 20
Failures in US leadership mean Americans face tough decisions with Festive Season. In Jan, China faced similar choices but w more uncertainty).

A short thread comparing & drawing lessons between:
– January China 🧧Lunar New Year🧧
– November United States 🦃Thanksgiving🦃

Starting with some case count comparisons between Lunar New Year in China & now in the US:

– 254.3 cases per day: China (Jan 25)
– 135,714.3 cases per day: US (Nov 12)

Much focus on China's success has been on lockdowns: a time when we didn't know much, didn't have widely available testing & govt support to ensure socio-economic protections. Now, lockdowns can be avoided with strong public health & health systems.


Read 13 tweets
13 Nov 20
Weekend Reading?

🌎New Publication🌏
The first in the ILIAID Consortium White Paper series on IHR Reform:

"Reforming the Declaration Power for Global Health Emergencies" by @clarewenham @alexandraphelan @MarkRTurner Sam Halabi.

Available here: georgetown.box.com/s/w0u7k6dwb740…

(1/7) Image
Why did we write this? In light of COVID19, suggestions to reform the mechanism for declaring a public health emergency of international concern (PHEIC) have gained renewed attention & political will. Any substantial reform of PHEICs will likely require amendment to the IHR (2/7)
Already, multiple international and regional processes to review global COVID-19 response, including the operation of the IHR, are underway, including @TheIndPanel, @WHO Health Emergency Program IOAC & the IHR Review Committee.
Read 7 tweets
4 Nov 20
We've warned of pandemics (inc. CoV) but govts have failed to act.

Special Rapporteur Prof David Boyd "Human rights have been a catalyst for the types of transformative changes that scientists are saying that we need"

#PandemicRecovery @Cambridge_Uni @BennettInst
"The achilles heel of international environmental law... is a lack of enforcement mechanisms, and human rights overcomes [that challenge]" David Boyd
#PandemicRecovery @Cambridge_Uni @BennettInst

I completely agree & have written more about this here:
Dame Barbara Stocking: "What about the next pandemic?"
"We are pressing to have a UN Convention on Pandemics as @WHO does not have the mandate: Member States do not allow it to have an inspector function or doing what is needed to be done"
#PandemicRecovery @Cambridge_Uni
Read 4 tweets
8 Oct 20
In past pandemic planning scenarios, we war game what would happen if the president and VP are both unable to fulfill their constitutional duties due to an infectious disease.

The Presidency, the Agencies, and Congress all have clear processes (set out below) but...

Presidential Succession Act (1947) sets out order:
1⃣Vice President (M. Pence)
2⃣Speaker of the House (N. Pelosi)
3⃣Speaker pro tempore (C. Grassley)

Then Cabinet members on dept creation order starting with4⃣State (M. Pompeo)5⃣Treasury (S. Mnuchin)

Senate: filled by appointment
House: filled by election (rules set by states)

Quorum is necessary for many activities: in light of 9/11, in 2003, 1st Continuity of Congress Report called for a Constitutional amendment to allow for temporary elections:
Read 5 tweets
13 Aug 20
Today, @nytimes has examined the CDC's data for excess mortality ("deaths above normal") over the pandemic.

Since March, at least 200,000 more Americans have died than usual.

That's ~60,000 more deaths than officially directly linked to #COVID19.

You can see the pattern of excess deaths match the movement of the pandemic across the US.

This suggests that official death counts may be substantially underestimating overall effects of #covid19: inc. deaths from SARS-CoV-2 & other causes linked to the pandemic.

Accurate counts during epidemics are challenging: mortality from past pandemics (eg 1918 & 2009 flu) have been recalculated afterwards.

But this shows how critical accurate data reporting systems are & why Trump Admin's decisions on data are so worrying:
Read 4 tweets
7 Jul 20
We've been working on something very exciting that I can now share!

🥁Introducing 🥁

COVID Analysis & Mapping of Policies #COVIDAMP

A resource for decision-makers, researchers & lawyers tracking US & global #Covid19 laws & policies ⚖️

1/10 Image
Starting with the COVID AMP interactive map, you first get a visual snapshot of US cases and a quantified scale of the level of physical distancing policy & laws in place for each state.


2/10 Image
Click on any state to see what laws & policies are currently active (repealed & relaxing policies are also in the data) like:
- business shutdowns
- mass gathering bans
- facemasks

Pop up also shows you the phase of recovery & number of new #COVID19 cases over last 7 days.
Read 12 tweets
11 Jun 20
Last night, US District Court ruled that police in Portland, Oregon are limited in using tear gas against protestors because, inter alia, the risk of irreparable harm given the #covid19 pandemic.

1. A thread on this decision & reflection on evidence between science & law.
2. The Plaintiffs claimed use of tear gas violates:
– Fourth Amendment (as excessive force as an unreasonable search and seizure) &
– First Amendment (chilling political speech)

For a restraining order, Ps had to show that irreparable injury is likely w/o injunction.
3. The Court made this finding after asking parties to provide further evidence on "the science of tear gas" and Covid19.
Read 13 tweets
29 May 20
Legally, can President Trump withdraw the US from membership of the WHO?

– The WHO Constitution is a treaty.
– Membership of WHO requires signing the WHO Constitution & completing state domestic ratification processes (art 4).
– US has ratified the treaty.
*From WHO side*
WHO Constitution does not set out an express withdrawal process. This is not unusual and it is generally accepted that States are free to withdraw from international treaties & institutions (principle of state sovereignty, enshrined in Vienna Convention)
*US side*
Legally it's murky if the President can withdraw. While Exec has power to sign treaties, ratification follows advice & consent of Senate.
– Some argue Exec thus retains power to exit treaties
– Others argue it requires Congress consent:
Read 6 tweets
22 Apr 20
Australia has called for legal amendments to give the @WHO power to investigate outbreaks similar to UN weapons inspectors.

1. How would this be done legally? What are the implications? I haven't done a thread in a while, so here we go.

2. When States revised the International Health Regulations after SARS in 2005 they sought to balance sovereignty w public health but there was a "subtle but undeniable dilution of sovereign control" @Gianlucaburci, w WHO able to investigate reports from other states/ngos/media.
3. Another example of this sovereignty dilution: if a State doesn't accept WHO's offer to assist with investigating reports of an outbreak they may have, WHO may share the report with other States if it poses a public health risk (art 10).
Read 9 tweets
13 Mar 20
The drum beat of my doctorate & work in international law & infectious disease has been: laws & norms, laws & norms.

Over last 4 years we've seen:
- Int'l level: int'l health laws ignored & norms weakened.
- National: chronic underfunding & dismissal of evidence-base.

2 years ago, I gave a talk @SydneyLawSchool @SydneyHealthLaw @USSC on this issue: rise of populism and impacts on global health (link below). I looked at how Australia & the US were underprepared for the next pandemic.

In the last line I said:

Last year, we launched the International Law Impact & Infectious Disease Consortium at @georgetown_ghss out of our concerns about the weakening of international laws and its impact on global health pandemic preparedness (but we need funding). (3/4)

Read 4 tweets