• [Dr. James Miller Wilson V (born 1969)] MD FAAP, Director at Ascel Bio World Infectious Disease Forecast Center

  • • "Kudos to Dr. Malone, DTRA, USAMRIID, PHAC, and Many Others. It is rare that I have the privilege to witness, on the ground floor, a major global public health event. And even rarer to give public kudos to one of the silent heroes among a huge group of heroes who contributed to the process. I am proud to present [Dr. Robert Wallace Malone (born 1959)]'s heroic contribution to the Ebola fight:

    • RW Malone MD is proud to have played a key role in enabling the enormous success of developing an effective Ebola vaccine within 12 months. August 2014, colleagues at the Department of Defense/[Defense Threat Reduction Agency] asked us to step in and help [NewLink Genetics Corporation] manage the project and develop the contracts necessary to move the "orphan" PHAC/rVSV ZEBOV vaccine forward quickly. We got the project on track, recruited our client, Focus Diagnostic Clinical Trials (FCT), to team with USAMRIID/WRAIR to develop and perform the immunoassays, put WHO leadership in touch with Pentagon leadership to expedite the initial WRAIR clinical trials, recruited the government of Norway to help fund the clinical research, used social media (LinkedIn) and then personal phone calls to recruit Merck Vaccines to join the project, recruited a management team, and lead the development of the BARDA and DTRA contracts - yielding over 200M$ in resources. Those were frightening times, but now we have a remarkably effective vaccine, developed in record time. The US Army Medical Corps, Medical Countermeasure Systems (MCS) and the DoD [Defense Threat Reduction Agency] (DTRA) took risks and got the job done, on time and on budget, with little fanfare, and we were grateful to have been able to serve and assist with this huge accomplishment.

    • While the above sounds like a promotion for Robert's consulting service, I am here to publicly say I watched him do this first-hand. I want to also heartily acknowledge and congratulate DTRA, USAMRIID, and especially our colleagues in Canada's PHAC. You all have done a terrific job here. WELL DONE."

• [...]

About

Dr. James M Wilson is the CEO and Founder of M2 Medical Intelligence, Inc. who specializes in operational health security intelligence, with a focus on the anticipation, detection, and warning of infectious disease crises. He has led the creation of several systems used for the anticipation and detection of infectious disease crises and disasters. Dr. Wilson was the first operations chief of the Department of Homeland Security’s National Biosurveillance Integration Center. Dr. Wilson led the private intelligence teams that provided tracking of H5N1 avian influenza as it spread from Asia to Europe and Africa, detection of vaccine drifted H3N2 influenza in 2007 and in 2014, warning of the 2009 H1N1 influenza pandemic, discovery of the United Nations as the source of the 2010 cholera disaster in Haiti, warning of the 2020 COVID pandemic and several investigations of alleged and confirmed laboratory accidents and biological weapon deployments. Dr. Wilson is a strong advocate for effective and accountable global health security intelligence and the need for credible and balanced threat assessments.

Experience

• M2 Medical Intelligence, Inc. ( CEO and Founder , Jan 2016 - Present · 6 yrs 2 mos : Reno, Nevada )

  • • M2 is a provider of medical intelligence services to the healthcare industry.

Education

• American Board of Pediatrics ( Board Certification in Pediatrics )

• Georgetown University School of Medicine ( Pediatrics, Pediatrics Residency Program , 2000 - 2003 )

• University of Cincinnati College of Medicine ( MD, medicine , 1995 - 2000 )

• Georgia Institute of Technology ( BS, Applied Biology , 1989 - 1992 )

1 Background

Potentially catastrophic biological events that threaten US national security are steadily increasing in frequency. These events pose immediate danger to animals, plants, and humans. Current disease surveillance systems are inadequate for detecting indicators early enough to ensure the rapid response needed to combat these biological events and corresponding public reaction. Recent examples of outbreaks include both the HIV/AIDS and foot and mouth pandemics, the spread of West Nile virus to and across the US, the escape of Rift Valley Fever from Africa, SARS, and the translocation of both mad cow disease (BSE) and monkey pox to the United States.

Biological surveillance systems in the United States rely most heavily on human medical data for signs of epidemic activity. These systems span multiple organizations and agencies, are often not integrated, and have no alerting capability. As a result, responders have an insufficient amount of lead time to prepare for biological events or catastrophes.

Indications and Warnings (I&Ws) provide the potential for early alert of impending biological events, per-haps weeks to months in advance. Sources of I&Ws include transportation data, telecommunication traffic, economic indices, Internet news, RSS feeds (RSS) including weblogs, commerce, agricultural surveillance, weather, and other environmental data. Retrospective analyses of major infectious disease outbreaks (e.g., West Nile Virus and SARS) show that I&Ws were pre-sent weeks to months in advance, but these indicators were missed because data sources were difficult to obtain and hard to integrate. As a result, the available in-formation was not utilized for appropriate national and international response. This illuminates a critical need in biodefense for an integrated system linking I&Ws for biological events from multiple and disparate sources with the response community.

2. Introduction

MiTAP (Damianos et al. 2002) was originally developed by the MITRE Corporation under the Defense Advanced Research Projects Agency (DARPA) Translingual Information Detection Extraction and Summarization (TIDES) program. TIDES aims to revolutionize the way that information is obtained from human language by enabling people to find and interpret relevant information quickly and effectively, regardless of language or medium. MiTAP was initially created for tracking and monitoring infectious disease outbreaks and other biological threats as part of a DARPA Integrated Feasibility Experiment in biosecurity to explore the integration of synergistic TIDES language process-ing technologies applied to a real world domain. The system has since been expanded to other domains such as weapons of mass destruction, satellite monitoring, and suspect terrorist activity. In addition, researchers and analysts are examining hundreds of MiTAP data sources for differing perspectives on conflict and humanitarian relief efforts.

Our newest MiTAP prototype explores the integration of outputs from operational data mining (anomaly detection), human language technology (information extraction, temporal tagging, machine translation, cross-language information retrieval), and visualization tools to detect SARS-specific I&Ws in Asia, with relevance to pathogen translocation to the United States. Using feeds from English and Chinese language newswire, weblogs, and other Internet data, the system translates Chinese text data and tracks keyword combinations thought to represent I&Ws specific to SARS outbreaks in China. Analysts can use cross-language information retrieval for retrospective analysis and improving the I&W model, save searches to use as filters on incoming data, view trends, and visualize the data along a timeline.

[...]

5 Acknowledgments

This work has been funded, in part, by the Defense Advanced Research Projects Agency Translingual Information Detection Extraction and Summarization program under contract numbers DAAB07-01-C-C201 and W15P7T-04-C-D001, the Office of the Secretary of Defense in support of the Coalition Pro-visional Authority in Baghdad, and a MITRE Special Initiative for Rapid Integration of Novel Indications and Warnings for SARS.

Objective. This paper describes Project Argus, a novel foreign biological event detection and tracking system.

Background. Currently, official notification of international health threats is provided by the World Health Organization (WHO), in partnership with the Global Outbreak Alert and Response Network (GOARN), and supported legally through WHO’s promotion of the International Health Regulations. WHO and GOARN utilize a service called the Global Public Health Intelligence Network (GPHIN) to scan media articles globally for references to disease outbreaks and epidemics. GPHIN is limited, however, by the volume of media material that can be processed in multiple languages. Additional limitations may prevent WHO from detecting and assessing a rapidly spreading epidemic, including the lack of a proper public health infrastructure in the country experiencing an outbreak, the involvement of a previously uncharacterized pathogen, or the WHO Member State’s unwillingness to report the event. [1, 2] Unofficial mechanisms also exist for reporting international heath threats, such as ProMED, a not-for-profit organization that relies on volunteers throughout the world who submit information about infectious diseases and surrounding issues. Most of these reports are media articles. In an attempt to display only the most relevant information, all submissions are processed by a group of volunteer moderators with substantial field expertise. This approach is limited by the number of staff available to process the volume of reports submitted throughout the world in multiple languages. [3, 4]

Methods. The purpose of Project Argus was to create and implement a global biological event detection and tracking capability that provides early warning alerts. The Argus analytic team consists of multilingual analysts that utilize proprietary state of the art online media processing software designed in collaboration with the MITRE Corporation combined with innovative open source analysis. We cover 34 languages with global sourcing. Identification of biological events is performed using a taxonomy of nearly 200 indicators coupled to a heuristic staging model called the Wilson—Collmann Scale. Once an event is identified, analysts then evaluate the report for possible posting as a Warning, Watch, or Advisory. The framework for alerting was derived heavily from the natural disaster and meteorological communities. Reporting requirements for both event detection and alerting were developed by Argus and then reevaluated on a quarterly basis by the US government for constant operational refinement.

Results. Argus currently manages between 2,200 to 3,300 active, socially disruptive biological event case files with update report threading for approximately 175 countries and over 130 disease entities. This past influenza season, the Argus team issued nearly 3,000 event reports across 128 countries and 27 languages, which included 181 Advisories, 58 Watches, and 38 Warnings. We identified hundreds of reports of a possible H3N2 drifted virus escaping the current vaccine compilation beginning eight months ago in a multitude of countries and collaboratively worked with CDC to track this important finding. This information ultimately contributed to the decision process by the World Health Organization and its partners to change the southern hemisphere influenza vaccine to include an updated H3N2 strain.

Conclusions. In summary, Project Argus has changed the expectations for biological event detection. The Argus methodology has been reduced to practice on a global scale and is now recognized as a novel professional analytic discipline by the US government.

References.

1. [Dr. David Lowell Heymann (born 1946)], Rodier G. Global surveillance, national surveillance, and SARS. Emerg Infect Dis. Available from: URL: http://www.cdc.gov/ncidod/EID/vol10no2/03-1038.htm [accessed 2003 Feb].

   1. 1. [ that link no longer works ... now use this : Emerg Infect Dis. 2004 Feb; 10(2): 173–175. / doi: 10.3201/eid1002.031038 / PMCID: PMC3322938 / PMID: 15040346 / Global Surveillance, National Surveillance, and SARS / [Dr. David Lowell Heymann (born 1946)]^* and Guénaël Rodier^{* /} .... https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3322938/ ]

      2. [ Note that, curously, Dr. David Lowell Heymann (born 1946) was before the US senate in early September 2001 talking about emerging diseases and bioterrorism... along with Dr. Joshua Lederberg (born 1925) .... see https://www.govinfo.gov/content/pkg/CHRG-107shrg75040/html/CHRG-107shrg75040.htm ]

      3. [ Note - Dr. David Lowell Heymann (born 1946) was the keynote of Global Outbreak Alert and Response Meeting April 26-28, 2000 ( World Health Organization, Geneva), which was the official kickoff of Global Outbreak Alert and Response Network (GOARN) , ,... see https://apps.who.int/iris/bitstream/handle/10665/66750/WHO_CDS_CSR_2000.3.pdf ]

      4. [ Wilson claims to have been part of efforts in the late 1990s that led to GORAN ... "In the late 1990’s, I worked with the World Health Organization and NASA to examine environmental and climatic phenomena in Africa potentially associated with the emergence of the Ebola virus. This work led to the first model for rapid identification of “conditions favorable” for Ebola epidemics using satellite imagery. It was during this time period that WHO and its partners initiated the Global Outbreak Alert and Response Network (GOARN), the Canadians created the Global Public Health Intelligence Network (GPHIN), and ProMED was started; indeed it was the birth of what we would later refer to as a new professional discipline in monitoring publicly available global information. " - July 2008 US congress testimony, [HX001X][GDrive] ]

2. World Health Organization. Global outbreak alert and response network [online]. Available from: http://www.who.int/csr/outbreaknetwork/en/ [accessed 2005 May 23].

3. Woodall J, Calisher CH. ProMED-mail: background and purpose. Emerg Infect Dis. 2001;7(3 Suppl):563.

4. Madoff LC, Woodall JP. The internet and the global monitoring of emerging diseases: lessons from the first 10 years of ProMEDmail. Arch Med Res. 2005

• Chairman Langevin, Ranking Member McCaul and Members of the Committee, I appreciate the opportunity to testify today about the Department of Homeland Security National Biosurveillance Integration Center (NBIC).
• My name is Dr. James Wilson, Chief Scientist and Chief Technical Officer of Veratect Corporation, a privately funded company with offices in Seattle, Chicago and Alexandria, Virginia. For more than ten years now, I have been pursuing a mission of early disease detection and tracking. I have had the privilege to have worked with and for the World Health Organization, NASA, NOAA, US Army, DHS-NBIC and several other Federal organizations, all with the intention of developing the art and science of timely, accurate, sensitive and specific detection and warning for disease – early enough to do something about it before it enters the global transportation and commerce grid. Perhaps the most relevant points in my career, for this discussion today, are my role as the first Chief of Operations at NBIC, Principal Investigator of Project Argus, founding member of the Biosurveillance Indication and Warning Analysis Community (BIWAC) and my current role at Veratect.
• Today I would like to cover five things;
  • • 1) A quick review of biological threats past to present.
    • 2) What our Nation’s response has been to date.
    • 3) Speak to NBIC’s mandate as it stands today, and what will be required for it to succeed.
    • 4) Share with you the next generation in early detection methodologies that we have developed, and are improving at Veratect.
    • 5) Suggest how Veratect can support NBIC and the National Biosurveillance Integration Mission.

Brief History of Biological Threats, 1918 to Present

• I would like to begin by sharing some historical context as we review past and present diseases. In the late 1990’s, I worked with the World Health Organization and NASA to examine environmental and climatic phenomena in Africa potentially associated with the emergence of the Ebola virus. This work led to the first model for rapid identification of “conditions favorable” for Ebola epidemics using satellite imagery. It was during this time period that WHO and its partners initiated the Global Outbreak Alert and Response Network (GOARN), the Canadians created the Global Public Health Intelligence Network (GPHIN), and ProMED was started; indeed it was the birth of what we would later refer to as a new professional discipline in monitoring publicly available global information.
• In 2003, several colleagues and I applied this idea to West Nile virus, utilizing the concept of “graded alerting” married to “graded response”, where clues of the emergence of a biological event sensitize a network of biosurveillance analysts to begin actively searching for more information that may ultimately yield a response action. That work evolved into the National Library of Medicine (NLM)-sponsored Project Sentinel, which examined the role of syndromic surveillance in biodefense. The most substantial realization of Project Sentinel was the possibility of connecting a global biosurveillance system seamlessly to hospitals in America using information technology so that patients would not be seen by American healthcare workers without access to immediate situational awareness of what that patient might have been exposed to while traveling overseas. This was a poignant note when considering the vulnerability of Toronto’s hospitals in 2003 when they unknowingly admitted suspect and confirmed cases of SARS that prompted quarantine and closure of their facilities.
• One of the things that history is teaching us now is that, in the context of influenza season, the impact on the medical grid is considered substantial, but brief. However, in the case of a pandemic, the possibility of a “medical blackout” becomes a serious consideration. America’s hospitals are not linked to near real time situational awareness, which is a serious issue given biological hazards can easily translocate undetected and un-forewarned in hours through the air traffic grid from Africa to New York and Asia to Los Angeles.
• Clearly, globalization and more specifically the transportation grid (as it has become more developed) has heightened the risk of transnational spread of disease. Just last week we saw a case of Marburg hemorrhagic fever transferred by flight from Uganda to the Netherlands. Currently, the US is experiencing the worst measles epidemic in ten years, which has spread to 15 states thanks to foreign introduction by returning travelers to the US. Of course, the Members are aware of the current national salmonella food contamination event that CDC and FDA are struggling to investigate, courtesy of our globalized commerce.
• According to the US Department of Transportation, the total bi-directional exchange of direct, non-stop air traffic between the US and the rest of the world was 81.4 million passengers in 1990. By 2005, bi-directional air traffic between the US and the rest of the world increased by 182% to 148.6 million. In 1990, bi-directional exchange between China and the US was 84,308 passengers with 3 Chinese cities connecting to 7 US cities. By 2005, this had increased to 1.5 million passengers, which is an increase of 1,819% with 9 Chinese cities connecting to 27 U.S. cities.
• It is obvious that international air traffic to and from the United States is steadily increasing. However, translocation of disease by aircraft has been reported with community exposures. Historically, the influenza pandemics of 1918, 1957 and 1968 and the HIV/AIDS pandemic were brought to the US through transoceanic ships and airplanes. Pathogens such as adenovirus, Chikungunya virus, the cholera bacterium, dengue virus, Ebola and Margburg hemorrhagic fever viruses, hepatitis A virus, human metapneumovirus, legionella bacterium, the malaria parasite, measles virus, mycoplasma bacterium, norovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus, salmonella bacterium, SARS-coronavirus, both seasonal and pandemic influenza virus, shigella bacterium, smallpox virus (historically), treatable tuberculosis as well as Multi- Drug Resistant (MDR-TB) and Extensively Drug Resistant (XDR-TB) forms of the bacteria, West Nile virus, and yellow fever virus have all been documented to have been vectored by aircraft.
• But no historical review of disease threats would be complete without some understanding of the 1918 Spanish influenza-H1N1, which infected 1/3 of the world’s 1.5 billion citizens and killed over 50 million of them. This pandemic took almost a year to spread from its origin to full global involvement. A contemporary 1918-like public health disaster could kill 1.9 million Americans and spread by passenger jets in as little as three to four weeks from source to global involvement. Our team has serious concerns that such an event may result in sustained “medical blackouts”, critical infrastructure failures and acute, overwhelming socioeconomic social disruption. Further, economic research suggests a possible 8 to 10 year global economic depression in a multi-trillion cost to the world economy. Such a scenario would have serious implications for our ability to project our military might, maintain our homeland security, and our national security, economy and society.
• So where are we today – what have we done?
• The U.S. stands at ever-present and increasing risk for further introductions of exotic infectious disease with potentially serious consequences to the nation. From my perspective in a near real time operations environment (which will be described below), we have hours or at most a few days to respond to an emergent threat. In other words, while consideration of intentional release or bioterrorism is important and key to national security, naturally occurring threats are more likely and have occurred regularly throughout history. Time-sensitive public health response is the best counter measure we have for both. Early detection is the key to early response and early containment.
• My initial work to anticipate the emergence of Ebola, explore graded surveillance for West Nile Virus and connectivity to hospital-based disease surveillance made evident the significant limitations of situational awareness relating to emerging global biological threats among our medical, veterinary, public health, and homeland security communities. We concluded that, particularly with regard to highly communicable diseases, there was a critical need for identifying the earliest possible indications and warnings of foreign biological threats to enhance our ability to proactively implement effective countermeasures. Again, early detection coupled with early response means early control.
• From 2004 to 2005, I volunteered my services as the Biodefense Technical Advisor of the US Army Medical Research and Material Command’s Telemedicine and Advanced Technology Research Center (USAMRMC-TATRC) to serve as a member of the National Biosurveillance Integration System (NBIS) Concept Design Review panel. In late 2005, I actively canvassed the Department of Homeland Security and the Homeland Security Council to assist with the operational activation of the National Biosurveillance Integration Center (NBIC). As its first Chief of Operations, and in conjunction with the talented people on the NBIC team, we drafted the first concept of operation.
• Except for BioWatch, we did not have access to operationally relevant biosurveillance information, because it simply did not exist at that point. While at DHS-NBIC, I interacted with representatives of Customs and Border Patrol, Immigrations and Customs Enforcement, the Transportation Security Administration, and the US Coast Guard who all told me stories of passengers and immigrants who presented with illness at the border. It was my impression that the coordination of situational awareness for these issues with CDC’s Division of Quarantine and Population Migration would be a powerful adjunct within NBIC’s mission of biosurveillance. It was in these early days we realized the need for a novel professional analytic discipline for integrated biosurveillance. With time, we came to understand that additional funding in a different setting was essential to develop the analytical methodology and discipline that would be so crucial to this historically unprecedented capability.
• Up to this point, NBIC had configured itself operationally in the manner of a military operations center not unlike the North American Aerospace Defense Command (NORAD). This included mission analysis, concept of operations and an operations plan that was implemented using information feeds from sources such as BioWatch, BioSense, Argus (further addressed below) and other sources of information. This was a historically unique operations center in my opinion in that we were now beginning to function with integrated and prioritized reporting requirements across the federal agencies. Unfortunately, the structure of the program was not optimal for its federal partners because it needed to be established in a neutral environment that brought federal agencies together as equals.
• After my departure, NBIC focused heavily on building formal relationships with the Federal Community. I did not see much support for detection subsystems nor substantive improvement in their early warning capability. I found there to be limited operational, routine, near real-time engagement between NBIC, their federal partners and state and local authorities. However, NBIC’s continued participation as a member of the Biosurveillance Indication and Warning Analysis Community (BIWAC) was an excellent step in the right direction. I will explain BIWAC in more detail below. It is my opinion the formal relationships needed for NBIC’s success will take years to develop, meanwhile the threat space continues to increase in complexity.

Response to Date, The Creation of the Argus Prototype

• Due in part to the emergence of SARS in southern China in 2002 and 2003 and the recent Highly Pathogenic Avian Influenza-H5N1 pandemic concern, DHS and the Intelligence Technology Innovation Center (ITIC) supported the activation of Project Argus in late 2004. Project Argus was established as a prototype research effort to explore the use of indicators to detect and track biological events, crises and disasters. I served as the Principal Investigator while serving as a faculty member of the Division of Infectious Disease, Department of Pediatrics, Georgetown University Medical Center. It was during the research and development phase of Argus that I also volunteered by services to the NBIS Concept Design review and later as the first Chief of Operations of the NBIC. Therefore, the design of both NBIC and the Argus prototype became synergistic.
• While at Georgetown University (we were housed at GU for convenience with little interaction with the rest of campus and no independent support from the University), we applied established proven methodologies to what would become a new analytic and professional discipline in biological event detection and tracking with a full time staff of cultural and linguistic and subject matter experts and analysts based upon state of the art technology provided by the MITRE Corporation. The approach is based on one of the recommendations of the 9/11 Commission to collect, analyze and correlate data from the world wide web as a source for information about indicators of social disruption caused by illness and disease. Although simple in concept it was an extremely complex system. The sponsors of our work deserve the nation’s thanks for having the courage to back our idea – which in retrospect is one of the most powerful national security ideas to have emerged from the post 9/11 period. We benefited from the enthusiastic intellectual support of many parts of the US government including CDC, USDA, DoD combatant commands around the world, and many others.
• In 2006, Congress supported activation of the Argus Research Operations Center, which was to be a prototype operations center for infectious disease event detection and tracking based on the methodology that we developed. Our mission was to monitor the world for the emergence and spread of H5N1 Avian Influenza. We later voluntarily expanded this mission to include 140 diseases the effect both animals and humans globally at no additional cost to the federal government.
• At this point I became Chief of the Argus Research Operations Center (AROC), but remained in strong support of NBIC and the National Biosurveillance Integration mission. It was my opinion that NBIC would not be able to achieve its objectives without an adequate detection subsystem; therefore I chose to focus my efforts on Argus and support NBIC from Argus.
• At our peak capacity, we estimated we were accessing over a million pieces of open source information daily covering every country in the world (except the United States) that resulted in the production of, on average, 200 reports per day. Using a disease event warning system modeled after NOAA’s National Weather Service, we issued Warnings, Watches, and Advisories in accordance with guidelines agreed upon by our research partners in the federal government. On average, we maintained 15 Advisories, 5 Watches, and 2 Warnings active on our Watchboard at any given time, with 2,200 individual case files of socially disruptive biological events maintained and monitored daily in over 170 countries involving 130 disease entities affecting humans or animals. We reached a maximum load of 3,300 individual case files maintained and monitored daily during the winter of 2007.
• This information, as provided to our mostly federal user community, sensitized them to be vigilant for the most concerning biological events in the world; this vigilance occasionally resulted in proactive requests for more information by our partners such as CDC and USDA. This in turn, contributed to the United States’ participation in the International Health Regulations through proactive information sharing with WHO and our international partners. Since the program had begun, we logged over 30,000 biological events in varying stages of social disruption throughout the world involving pathogens such as H5N1 avian influenza, other influenza strains, Ebola virus, cholera, and other exotic pathogens. Of note, while the majority of these events were naturally occurring, this capability identified several laboratory accidents and occasionally allegations of intentional use of biological agents.
• Upon invitation by CDC, we presented the results of our efforts to the G8 Health Security Advisory Group in February 2008. To the best of our knowledge, our approach achieved unprecedented operational milestones in comparison to the leading global biological event detection and tracking systems such as ProMED, the Global Public Health Intelligence Network (GPHIN), HealthMap and MedISys. One of the key observations by the G8 members was a unanimous desire for there to be a human interface between the raw data and elicited warning information; there was strong support for nurturing a new professional discipline devoted to near real time operational biosurveillance.
• The following examples highlight some of our achievements:
  • • The operations team at Argus, the majority of whom are now working for Veratect, served the country as the lead tactical global event detection team for H5N1 avian influenza and were the first group in the world to detect the expansion of H5N1 from southern China to Russia and then Eastern Europe. During the winter of 2007, we filed over 12,000 reports of events possibly related to H5N1 avian influenza.
    • In late 2004 and early 2005, we participated in the tsunami response by providing daily situational awareness reports to humanitarian responders. In commenting on our operations, the US Pacific Command wrote, “Information is power only when it's shared. The situational awareness that portions of Argus provided during tsunami relief efforts was an impressive attention step. We see some tremendous opportunities and value added for this capability within our area of operational responsibility, which literally covers half the globe. Thanks for keeping our situational awareness up during difficult times.”
    • On August 3, 2007, this team was the first to notify the US government of undiagnosed vesicular disease in cattle in Surrey, United Kingdom that later was diagnosed as hoof and mouth disease (FMD). Of additional interest, this event was later found to be the result of a laboratory accident, and intentional release was explored as a possible etiology but later discounted. The Members may recall the tremendous economic damage observed during the last epidemic of FMD in the UK in 2001.
    • On August 27, 2007, we were the first to report indications of the Ebola epidemic in Kasai, Democratic Republic of the Congo. This information was made available immediately to CDC, and other members of the Federal user community. CDC’s collaboration in rapid access to ground verification information through its partnership with WHO and other international partners was impressive, as it highlighted the potential reduction of the time between initial event detection to ground verification to hours and days as opposed to weeks or months. Again, early detection plus early response equals containment.

H3N2 Vaccine Drift

• Influenza kills an estimated 250,000 to 500,000 people globally each year. While monitoring the current pandemic threat of H5N1 avian influenza, the team also monitored all influenza strains in support of global influenza disease monitoring. During the winter of 2006 and 2007, the team issued nearly 3,000 event reports across 128 countries and 27 languages, which included 181 Advisories, 58 Watches, and 38 Warnings. Our team identified hundreds of reports of a type A / H3N2 influenza virus that appeared to have drifted away from the current vaccine strain of H3N2 beginning in early January 2007 in Beijing, China, six weeks prior to the WHO Consultation on the Composition of Influenza Vaccine for the Northern Hemisphere. We later found similar reports in a multitude of countries and collaboratively worked with CDC to track this important finding. The value of this information was validated when the World Health Organization and its partners recommended a change in the southern hemisphere influenza vaccine to include an updated H3N2 strain.
• The most important lesson from the H3N2 vaccine failure is not just the need for a robust comprehensive early detection system, but open and ongoing information exchange between government agencies and other global health organizations. The lack of transparency to the vaccine development process has resulted in unnecessary deaths here in the United States.
• During the subsequent 2007 and 2008 influenza season in the US, the northern hemisphere vaccine for the type A H3N2 virus provided suboptimal coverage at 58% effectiveness. This does not mean the vaccine was not helpful in terms of reducing the severity and burden of disease. However, although the vaccine achieved some degree of coverage, it was less effective than vaccines used in previous years due to the strain mismatch. The 2007 and 2008 influenza season was severe, with pneumonia and influenza-related mortality above epidemic threshold for 19 consecutive weeks compared to an 11 consecutive week maximum documented in the prior three seasons. This represents a 170% increase in seasonal deaths seen since the 2004 and 2005 season. Forty-nine states ultimately reported widespread transmission. In February, one physician commented in ProMED, “I have not seen in my 30 years of practice such a relatively large number of patients presenting with documented influenza vaccine ‘failure’."

Shortcomings of the Prototype

• Unfortunately, by operational design, the prototype was not able to monitor what occurred with that strain of influenza here within the United States. From CDC, we learned that there had been an increase in H3N2 clustered initially around regions of the United States connected directly to China by international air flights. Later laboratory reports from CDC indicated this virus had drifted away from the existing vaccine strain. We noted that the very same week we became concerned about reports in Beijing of an unusual strain of H3N2, vaccine-drifted H3N2 isolates were reported in US cities connected to Beijing by direct air traffic. We did the best we could do with the prototype, but it was not adequate. If precise surveillance of influenza “hot spots” was acted upon with vigorous sampling, we believe history might have been different.
• Let’s be clear here. As illustrated in the July 10, 2008 issue of Nature magazine, the northern hemisphere, including the United States, missed an opportunity for anticipating a bad season of influenza because, 1) information was not used proactively to acquire influenza samples from suspicious event/areas in the world, and 2) our most mission critical surveillance was blinded at home. This was one of the biggest difficulties with the prior system as it was set up at Georgetown.

NBIC Mandate and the BIWAC

• For NBIC to successfully execute its mission, it needs to leverage the experience of its federal partners. One of the early examples of this was the working relationship of NBIC and BIWAC.
• To facilitate operational validation, my colleagues and I initiated the creation of the unofficial, federal Biological Indication and Warning Analysis Community (BIWAC). As mentioned above, it was BIWAC that reviewed our reporting requirements with us on a quarterly basis to ensure proper product alignment with the user. BIWAC currently includes CDC’s Global Disease Detection team; USDA’s Centers for Epidemiology and Animal Health (CEAH); DHS’ National Biosurveillance Integration Center; the Armed Forces Medical Intelligence Center; other Intelligence Community organizations; the Defense Threat Reduction Agency; and the US Strategic Command Center for Combating Weapons of Mass Destruction.
• The BIWAC created a central clearing base where each member contributed what he or she knew about emerging disease and to quickly determine coordinated next steps that included event verification and, in some cases, actual ground response. To enhance this process, we activated Project Wildfire, which was an experimental information sharing system that enabled near-real time, unclassified dialog among the BIWAC partners. Wildfire, although experimental, attracted a substantial amount of federal use; for the first time, we saw the power of the National Biosurveillance Integration Mission in the daily activities of the BIWAC.
• The success of BIWAC and the Wildfire experiment was tempered by the observation that ground verification of biological event information was severely limited both in terms of types of disease covered as well as geographic coverage. We realized that the actionability of the information was therefore impaired without near real time interaction with such international partners as NGOs (who are often on the front lines as diseases emerge) and UN organizations. One key implication was a requirement for a near real time functioning global network. Another implication was the realization that there will be times when we will be unable to verify warning information in the face of daily, non- stop air traffic. A recent example of this would be SARS in 2003, where by the time a global alert was issued, the disease was already present in eight countries, including the United States.
• The Committee is already familiar with the fact SARS was present in China many months before WHO awareness and the Global Alert was not issued until eight countries (including the US) were already affected. It took four months to interrupt all chains of transmission that ultimately affected 27 countries on all continents except Antarctica. I would point out the same phenomena has occurred in the past including the 1957 and 1968 pandemics. Local authorities in Hong Kong reported unusual respiratory disease that inundated multiple urban sectors of their city nearly a month in advance of WHO’s public acknowledgement of a global threat referred to as a “pandemic”. By then the disease was already in the air traffic grid.
• I will note here there was evidence in both pandemics that Mainland Chinese public reporting of unusual respiratory disease preceded reporting in Hong Kong by at least several weeks. In summary, the 1957 and 1968 pandemics and 2002-2003 SARS all were reported at the local level well in advance of national Ministries of Health and WHO awareness or the issuance of a warning to the world. Again, near-real time global disease detection and tracking is essential for our nation.

Veratect and the Future of Biosurveillance

• The Argus program, although a successful prototype, had two critical flaws. First, we were unable to extend our process to include domestic biological event detection and tracking. Second, we were unable to build global partnerships with organizations whose missions could be greatly enhanced with this information. This was concerning as we realized other natural hazard warning systems such as tornado forecasting in the 1950s came under public scrutiny and criticism when it was discovered that a successful forecast of a deadly tornado was not shared by the military with the local community that received the onslaught of the storm. What was more important was not the high false positive rate but that a successful forecast could have provided hours of lifesaving warning beforehand. We saw the Argus program coming under similar scrutiny some day; our team felt we had an ethical and moral responsibility to address this concern.
• Because of these mission-crippling limitations, all the founding members and many of the most skilled analysts from the original Argus team decided to leave the prototype program and begin anew in a private industry environment, the Veratect Corporation.
• Veratect’s mission is to provide the earliest detection of threats to human, plant and animal life while empowering corporations, government organizations, NGO’s and global citizens with trusted and actionable information.
• Our domestic capabilities and global partnerships, together with Veratect’s new ForeShadowTM operating environment and VeraSightTM interface represent a significant step forward in the early detection and 24x7 tracking of biological events that empowers early warning and response from a broad range of private and public stakeholders that share these same risks. Our team of cultural and linguist interpreters with deep domain experience in recognizing pathogens at their earliest emergence represent 230+ person years of international experience and nearly 100 person years of experience in this new and proven professional discipline.
• With nearly five times the sources of the prototype, we have an estimated coverage of 82% of the world’s population now, in near real time. By the end of 2008, we will have expanded this coverage to more then 90%. Additionally, we are in discussions to have access to more than a quarter-million correspondents on the ground globally to support near real time ground truth verification. We stand ready to not only meet the needs of DHS and other federal agencies, but also local, tribal, and territorial governments in all 50 states. We currently monitor over 200 diseases that affect humans or animals, and our methodology is being expanded to include monitoring for biothreats to food security and crop disease.
• For this approach to be successful, there is an absolute requirement for human analysts who serve as the intermediary between the raw data and the interface with those who may take further action like CDC or USDA. Having a close relationship with these users ensures we maintain a proper level of sensitivity and specificity, as well as conduct continual quality assurance and reviews of our standard operating procedures. This distinguishes our efforts from that of other systems that produce raw data outputs such as HealthMap. As mentioned earlier, the G8 Health Security Advisory Group, it was clear the G8 members were more interested in humans serving as an interface with the data versus being shown raw, unmediated data outputs.

Veratect, NBIC and the Global Mission

• The team at Veratect has a unique perspective of what NBIC should do to meet the congressionally mandated mission objectives. Members of our team at Veratect have worked closely with DHS-NBIC from the very beginning. For the last two years, our team has been an important source of information for the entire federal government in the support of our Nation’s biosecurity.
• NBIC is chartered to collect and consolidate near-real time information on biological events using in part, resources within the Federal government and make those consolidated resources available to the Federal user community charged with meeting biological threats.
• We believe in this mission, and we look forward to working with DHS-NBIC again, and this time with far greater resources and capabilities. Veratect has offered to provide our analytical early warning system to NBIC and protect the US from the threat of infectious disease, it should also be noted that this will also provide significant benefits to the rest of the world. Disease is the common enemy of every human on the planet.
• NBIC’s mission (as outlined in HSPD-7, -9, -10; NSPD-33; and Public Law 110-53), is a valid and critically needed function for both the United States and for the support of our international partners through the International Health Regulations, the World Animal Health Organization (OIE) Terrestrial Animal Health Code, the Biological Weapons Convention, and safety monitoring for biotechnology.
• For the United States, a large number of biological crises and disasters are mostly imported events, as exemplified by the introductions of HIV/AIDS; West Nile virus; monkeypox; SARS and all four of the major influenza pandemics of the past 100 years. Influenza pandemics are generally believed to start outside the US; the next pandemic will most likely come from a foreign location. Our best defense is based on early detection.
• The current concern of an H5N1 influenza pandemic highlights this concern as well. As stated in the 2007 World Health Report, “It cannot be over-emphasized that a truly effective international preparedness and response coordination mechanism cannot be managed nationally. Global cooperation, collaboration, and investment are necessary to ensure a safer future. This means a multi-sectoral approach to managing the problem of global disease that includes governments, industry, public and private financiers, academia, international organizations and civil society, all of whom have responsibilities for building global public health security.”
• We can support the role of NBIC to protect our country by facilitating early recognition of biological events that may pose threats to our nation’s security, food production systems, and citizens’ well being. The spirit of NBIC’s mission may be seen across other public emergency warning systems. As with those systems, a critical requirement for NBIC is reliance on detection subsystems that include not only the information they provide but the subject matter expertise behind it.
• Veratect is also able to support a turnkey portal for foreign and domestic biological event detection and tracking with extensive ground truth validation that can be shared with NBIC’s federal, state and local partners. The benefits of immediate access to this portal will include access for CDC, USDA, FDA, DOD and other federal partners who can then engage in more effective coordination of disease surveillance and response.
• By the nature of our business, we can assist NBIS by working in collaboration with other stakeholders in global health including transnational corporations, NGOs and friendly foreign governments. US corporations are increasingly concerned about how emerging diseases might affect their own employees and indigenous workers, production partners and supply chains. Foreign corporations operate in areas of interest to the US and include oil, mining, manufacturing and food production. Their partnership is key to NBIC’s mission success.
• We are prepared to support NBIC’s implementation of its mission objectives by the end of August 2008. Our team and portal is available immediately and we stand ready to support a user community that is well known to us.
• There is an opportunity for the US to lead the world by example once again. The US has been the one to lead that development of many other societal warning systems over the years. Here we can be the leader in supporting implementation of the new International Health Regulations along with our international partners. We can demonstrate to the world our moral and ethical strength by assisting NGOs in saving lives. We can support our domestic industry competing in the global marketplace. And most importantly, we can finally support our local city, county and state officials in biosurveillance. In the end, we are here to ensure the US maintains technical supremacy in global biosurveillance in these uncertain times.
• I have three closing comments that speak to where we go from here:
  • • 1. It is in the national and global interest for the NBIC charter to be implemented immediately. This envisioned system will help protect human, animal and plant life, the national food supply and critical infrastructure against the common enemy of disease. The first step is early detection. We are doing that today.
    • 2. Veratect provides a superset of capabilities, resources and global relationships with private and non-profit organizations that can be of the greatest value to NBIC in meeting its mission. What we do is not reliant upon the NBIC system. We can provide NBIC with a fully operational early disease detection and tracking system today.
    • 3. The disease risks are real and we are on borrowed time. We are fortunate that the SARS epidemic and this year’s H3N2 vaccine mismatch were not more disruptive. And we remain very much exposed to an influenza pandemic. My colleagues and I at Veratect are eager and ready to support the national mission today.
• I would like to thank the visionaries in the federal government and Congress who supported the research and development that led us to this point, the courageous men and women of the BIWAC for their partnership and the Veratect Team for their hard work in operationalizing this critically important national asset. While none of us feel that we are, as a nation, where we need to be in terms of addressing the risks I have covered here today, I believe that Veratect can uniquely assist NBIC in rapidly achieving its goals.
• Once again, I am grateful for this opportunity to testify, and I stand ready to answer any questions you might have.
• Thank you.

• James M. Wilson V, MD is the Founder and Executive Vice President of AscelBio and Executive Director of Praecipio International. AscelBio, a for-profit corporation, provides consulting services to its clients for infectious disease risk assessments. Praecipio International is a nonprofit corporation dedicated to enhance and improve international public health and security against biological threats. Prior to his current position he was a Founder and the Chief Technical Officer / Chief Scientist of the Veratect Corporation in Seattle, Washington; Founder and Principal Investigator of Project Argus, Chief of the Argus Research Operations Center; and Division Head of Integrated Biodefense at the Imaging Science and Information Systems Center, Georgetown University. He was the concept, development, and operationalization lead for the new professional discipline of operational biosurveillance and lead architect and the founding member of the Biosurveillance Indication and Warning Analysis Community (BIWAC). Dr. Wilson received a Bachelor of Science in Applied Biology at the Georgia Institute of Technology, his medical doctorate from the University of Cincinnati College of Medicine, and trained as a pediatrician at Georgetown University Medical Center."

• Tracey S. McNamara, DVM is a Diplomate, A.C.V.P., Professor of Pathology at Western University of Health Sciences College of Veterinary Medicine in Pomona, CA.

• She graduated from the New York State Collegeof Veterinary Medicine at Cornell University. She served as senior zoo pathologist at the Bronx Zoo from 1987-2003 and held the Schiff Family Distinguished Scientist in Wild Animal Pathology endowed chair. Dr. McNamara specializes in the recognition and understanding of the diseases of captive and free-ranging wildlife and is best known for her work on West Nile virus. Her role in the discovery of the West Nile virus is described in the September 2000 GAO report “West Nile Virus – Lessons for Public Health Emergency Preparedness”,“Germs” by Judith Miller and “Secret Agents” by Madeline Drexler. In The Scientist (March 4, 2002), she is credited as having “served a central role as a unifying force, molding and sometimes forcing interrelationships between local and federal government agencies and private enterprises, enabling progress toward the common goal of monitoring a newly emerging disease in the United States.”

• Dr McNamara has served as a consultant to the National Biosurveillance Advisory Subcommittee and will be actively involved in the development of the Nation’s biosurveillance strategy through 2012. Most recently, she was asked to serve as lead on a project with Russian colleagues on the “Human-Animal Interface” by the Nuclear Threat Initiative’s Global Health and Biosecurity program in Washington DC.

It is every government’s dream: a system that can predict future events such as riots, political upheavals and the outbreak of wars. Last week, a collection of academics and private businesses was scrambling to meet the deadline for proposals for research aiming to do just that.

The Intelligence Advanced Research Projects Activity (IARPA), a research arm of the US intelligence community, is sponsoring the work under the Open Source Indicators (OSI) programme. The three-year project, with an unspecified budget, is designed to gather digital data from a range of sources, from traffic webcams to television to Twitter. The goal, according to IARPA, is to provide the intelligence community with predictions of social and political events that can “beat the news”.

Initially, the OSI project will focus on Latin America, which has abundant publicly avail- able data and offers a convenient test bed for researchers’ models. Those models will build on strategies that have already shown prom- ise for predicting disease outbreaks and consumer behaviour, and which are becoming increasingly popular with US national security agencies (see Nature 471, 566–568; 2011).

Indeed, the OSI project is one of many being sponsored by the US national security community, which seeks to meld mathematics, computer science and economics with the social sciences, creating a new field of social and political forecasting that has often been compared to Isaac Asimov’s concept of ‘psychohistory’.

At the Center for Collective Intelligence at the Massachusetts Institute of Technology in Cambridge, computer scientist Peter Gloor has been working with colleagues to build models that can predict consumer behaviour, such as ticket sales for Hollywood films, using a range of online sources including social media. “We’re up to 90% accuracy” for predicting box-office returns, says Gloor, who is part of a team applying for OSI funding.

John Brownstein, an epidemiologist at Harvard Medical School in Boston, Massachusetts, is working with a group that analyses international news sources, government data and social media to provide an early warning of disease outbreaks. He is also applying to work on the IARPA project. “In many cases, what we are searching for are patterns of activ- ity that would not only apply to disease events but to conflicts, environmental disasters and other forms of social disruption,” he says. However, there is disagreement about how effective such biosurveillance programmes have been. Picking up hints of an H1N1 outbreak is less useful if it is swamped by false alarms, says James Wilson, a medical doctor and the co-founder of Ascel Bio in New York. “There is a huge difference between a computer harvesting data and beginning to move communications so that people begin to contemplate action,” says Wilson, whose company is applying for OSI funding.

DATA CRUNCHING

The approach is nevertheless catching on in the financial sector. Christopher Ahlberg, the chief executive of Recorded Future in Bos- ton, also applying to the OSI project, says his company has proprietary software that can crunch through 300,000 sources an hour for clues to future stock movements. The company has already received investment from In-Q-Tel, a venture-capital firm in Arlington, Virginia, founded by the US Central Intelligence Agency, and is mining online data sources, such as Twitter, in an effort to predict cyber attacks and developments in the ongoing ‘Occupy Wall Street’ protests.

There is already plenty of published literature on predicting stock market volatility based on open sources, says Kalev Leetaru, a computer scientist at the University of Illinois at Urbana-Champaign. But that’s a long way from being able to predict a riot next Wednesday. Leetaru, who is also part of a team apply- ing to be part of the OSI project, says he asked IARPA whether it would consider a broader approach that involved predicting trends, such as the Arab Spring movement, rather than focusing on specific events (see Nature http:// dx.doi.org/10.1038/news.2011.532; 2011). The answer, he says, was “no”.

“In my mind,” Leetaru says,“this would be akin to the National Institutes of Health announcing it was terminating all funding for work on cancer drugs that targeted individual cancers or that slowed cancer down, and instead announcing that they would only fund a single miracle pill that you take and your can- cer is cured the next morning.”

Robert Albro, an anthropologist at American University in Washington DC, and an expert in Latin American social movements, believes that IARPA is mistakenly presuming that social media will provide high-quality data. “Just because data are available doesn’t make them good, or the key to the kingdom,” he says.

A bigger question is whether models used to measure consumer preferences and disease outbreaks are applicable to the complex world of social change and political events. Albro says that such models make faulty assumptions about what motivates humans, and he worries “that companies concerned about consumer behaviour are now driving how IARPA thinks. That’s a leap of faith.” ■

Ebola, cholera, swine flu.

There are deadly viruses out there, but an internationally renowned expert on tracking them recently joined the faculty of the University of Nevada, Reno, and he plans to set up a center here to forecast what infectious diseases are expected to spread across the state.

Dr. James Wilson, who has served as a senior technical adviser to the U.S. Department of Homeland Security's National Biosurveillance Integration Center, spoke Monday about the chances of Ebola spreading to the United States, and what virus poses an even greater threat to humanity.

"Ebola, let's face it, is the hot sexy topic de jour," he said from his office in UNR's School of Community Health Sciences.

"Sure, Ebola can come to the United States. In fact we expect to see one or two cases come here in the form of returning travelers," said Wilson, who was interviewed on CNN last week about the outbreak in several African countries.

"That said, what is a disaster for West Africa, in austere medical and health environments, is not expected to be a disaster here," he said. "I think one of the questions we deal with often is does this has pandemic potential? Is there a doomsday scenario here? And we can say emphatically, absolutely not."

Ebola is not easily spread, and requires close contact and the transfer of bodily fluids such as blood, Wilson said.

It cannot be spread by sneezing, a myth that a number of doctors still believe, he said.

And Nevada's relatively low air traffic numbers, as well as its lack of a substantial number of first-generation immigrants from West Africa who might go back home to visit, puts it at low risk of seeing the virus emerge in the Silver State, he said.

"That's good news for you, but the flip side is missionaries. If have lot of missionaries going over there, then everybody has to be on their toes because they might come back with it, especially if they're working in medical areas," said Wilson.

Hollywood has stoked people's fears with such movies as "Contagion" and "Outbreak" and "The Andromeda Strain," but Ebola is not an easily transferred pathogen, he said.

"As a society, we love to be scared, but this is not a situation that warrants that kind of worry or fear. You may expect to hear more and more of suspect cases in the Philippines, Hong Kong, the United Kingdom, and even here in the United States," Wilson said.

But he said people shouldn't be alarmed because these suspect cases often come back negative.

Wilson is the founder and executive vice president of AscelBio, a for-profit corporation that provides consulting services to clients for infectious disease risk assessments.

He also headed the Black Canyon Infectious Disease Forecasting Disease Center in Delta, Colo., and will be creating an infectious disease forecasting center at UNR.

Gov. Brian Sandoval's Commission on Economic Development asked him to come to Nevada and join the faculty at UNR

"We have been invited to come here and help create what is essentially the company's first state-based infectious disease forecast station, and the forecast and warning protocols are modeled directly after the National Weather Service," he said. "So we will have the world's most powerful technology to do that right here in the state."

Wilson played a key role in recognizing and warning the Centers for Disease Control and Prevention of the coming of the 2009 H1N1 influenza pandemic. He also foresaw the coming cholera outbreak in Haiti following the 2010 earthquake and led multiple ground operations to combat the illness.

With the creation of statewide infectious disease forecasting center at UNR, Wilson hopes to create a system for public health reporting similar to what the National Weather Service does, but warning about potential or emerging outbreaks of infectious diseases instead of coming storms.

His company's forecasts are based on using what he calls signal processing algorithms.

"Human behavior exhibits a pattern," he said. "We found something like a DNA code for human behavior and we track that. That's the dark part of our art. Then we use artificial intelligence that analyzes hundreds of indicators in a source-of-information form for any location in the world."

While Wilson doesn't see Ebola as a big threat to humankind, he said there is a virus we should be worried about.

"Hands-down, without any question whatsoever is the emergence of a rapidly transmissible novel influenza virus," he said. "That is the number one concern that we deal with every single day, regardless of whether were seeing Ebola, SARs (severe acute respiratory syndrome) MERS (Middle East Respiratory Syndrome) or even the threat of bioterrorism. What we worry about is a novel influenza virus because it is a very efficiently transmitted pathogen."

Dr. Trudy Larson, director of UNR's School of Community Health Sciences, said in addition to establishing the center, Wilson will create and teach a new course that will be offered on forecasting infectious diseases.

She hopes the class can be offered by the spring 2015 semester.

"Forecasting infectious diseases is a new way of looking at data, and students will need to understand how to use that as they go into their public health careers," Larson said.

"Dr. Wilson started this many years ago and came in very early on in this field, which gives him exceptional insight into how we might use and improve it," she said. "It's like an early warning system that could he has developed and validated that does provide a very important opportunity to prevent and control infectious diseases."

As an associate research professor who also will work as a pediatrician at UNR's clinical services, Wilson has a 12-month contract and will earn an annual salary of $140,000.

James Wilson, recently hired to the faculty of the School of Community Health Sciences, is in the process of developing a University-based, national forecasting center for infectious diseases.

Against a backdrop of current news about outbreaks of deadly disease, the University of Nevada, Reno's Division of Health Sciences recently announced that an infectious disease forecasting expert has joined the faculty of the School of Community Health Sciences.

James Wilson, M.D., created an algorithm-based mechanism that forecasts the spread of infectious diseases worldwide and is used by the Centers for Disease Control, Department of Defense and other national agencies with interest in monitoring these developments.

Now, as a University faculty member, Wilson is beginning the process of developing a forecasting center to track the spread of infectious diseases in Nevada. The goal is to accurately forecast the growth of such conditions so that preventative measures may be put in place early on to avoid overloading the health care system and putting a strain on precious resources as physicians and health care institutions strive to catch up following an outbreak.

"We took a page from the science of weather forecasting to do the same for diseases ranging from foot-and-mouth disease to strep throat to plantar warts," Wilson explained. "Using the same processes, we can forecast a variety of medical conditions."

"In public health we are most interested in the prevention of disease, and work such as Dr. Wilson's represents an exciting new frontier for early prevention," Trudy Larson, M.D., director of the University's School of Community Health Sciences, said.

Wilson has been involved with the Ebola response in terms of forecasting the spread of the virus and developing public education as to the disease and preventative measures to be taken against it.

"The forecasting we do is a powerful driver to educate people about these diseases and for patient education. Some may even reconsider their belief system on vaccinations and in that way, we can help people make the right choices," he said.

Wilson chose to move his infectious disease forecasting center to Nevada due to the synergy with the University and the people here.

"It was the spirit of collaboration, the willingness to innovate, the existing faculty expertise and the research capacity of this University," he explained, adding that he will be training students in the relatively new discipline of infectious disease forecasting and early warning and growing the next generation of analysts who may go on to work for the private sector, the government or become physicians and health care providers.

In some cases of "stable" diseases, Wilson's forecasting model is accurate enough that he can tell how many cases of a particular disease will be diagnosed on a certain day of a given year.

Wilson, who carries the title of research associate professor at the School of Community Health Sciences, is a board certified pediatrician and a Fellow of the American Academy of Pediatrics.

He is the founder and executive vice president of AscelBio, a for-profit corporation that provides consulting services to its clients for infectious disease risk assessments, and director of the AscelBio National Infectious Disease Forecast Center.

He is also founder and executive director of Praecipio International, a non-profit corporation dedicated to enhancing and improving international public health and security against biological threats by stimulating collaboration within and offering education to the international, multi-disciplinary humanitarian community. Wilson has served as an infectious-disease advisor to many organizations including the Department of Homeland Security and National Biosurveillance Integration Center, World Health Organization and NASA.

NEW YORK, July 5, 2016 /PRNewswire-USNewswire/ -- Live forecasts issued today by Ascel Bio show an elevated risk of Zika transmission in Key West, the southeastern shore of Louisiana, Atlantic City, Brookhaven Mississippi, and multiple sites in Hawaii. Ascel Bio produces the only Zika risk NowCast for the entire USA.

Climate conditions at many sites in HI, FL, LA, NJ, and MS now promote the breeding of the Aedes aegypti mosquito, the most important vector for Zika virus. Concerted efforts to reduce the risks from the Aedes aegypti mosquito are recommended for residents and health officials in these areas.

Ascel's bio-meteorologists say mosquitos that carry the disease (including the Aedes aegypti mosquito) breed when weather conditions are right. There is currently no ongoing transmission of Zika in the continental United States. So far, Americans have been infected by traveling outside of the US to Brazil and other countries.

Patrick Wedlock, Ascel Bio's senior forecasting officer states:

Each day we update our forecasts to show where the risks of Aedes aegypti mosquito growth are in the United States. The CDC has issued a warning that there are a number of high risk cities in America for these mosquitos. Ascel Bio's Zika NowCasts are unique: giving live updates in real-time on the locations where risk is increasing.

In order for Aedes aegypti mosquitos to actually transmit the disease, they must bite someone who has the disease, and as such, a person harboring the Zika virus must be present and bitten in one of these locations in order for local, mosquito-borne transmission to occur. To date, there have been no such locally transmitted cases of Zika virus in the mainland United States.

Hundreds of health conditions have well-established links to the environment. Ascel Bio provides disease forecasts, outbreak alerts and other insights to users concerned with these conditions, bridging gaps between climate knowledge and healthcare. Ascel Bio's Zika NowCasts present opportunities for action and improved global health. Ascel Bio continues to work together with the healthcare community to combat Zika and other seasonal infectious disease outbreaks.

A University of Nevada, Reno, expert who played a key role in investigating a 2010 outbreak of cholera in Haiti that was later blamed on U.N. peacekeeping troops says the international organization needs to do more to ensure that it doesn’t contribute to the spread of infectious diseases.

Dr. James Wilson, director of the Nevada State Infectious Disease Forecast Station at the University of Nevada, Reno, was leading a nonprofit public health group after a devastating earthquake hit Haiti in 2010 when he and his colleagues identified U.N. troops from Nepal as the apparent source of the outbreak.

That spadework was part of an accumulation of data that ultimately led to the United Nations’ admission last week that its peacekeeping forces played a role in introducing cholera to the Caribbean nation – an acknowledgement that came the same day its immunity in a class-action lawsuit was upheld in court.

Wilson was working with a team from the nonprofit public health group Praecipio International when reports of the disease began trickling in.

“We really were questioning, ‘How the heck did that get there?’ because it just wasn’t in the peer-reviewed literature, and there were a lot of questions about what the heck is cholera doing in Haiti,” he said.

Wilson and his team ended up playing a key role in tracking the spread of the disease and determining its source.

They already had set up and were managing the Haiti Epidemic Advisory System, which used reports from agencies including the U.N. and Haiti’s Health Ministry to forecast the spread of infectious diseases.

The team was preparing to shut down when they began receiving reports of unusual diarrhea cases in October 2010. Within days, those cases were confirmed to be part of a growing cholera problem.

Wilson said most governmental agencies and nongovernmental organizations were understandably focused on preventing the potentially deadly disease from spreading and considered finding the source of the outbreak a secondary concern.

But he said he had suspicions about the source when he called the U.S. Centers for Disease Control and Prevention and was told the cholera was a type mainly found in Asia.

Soon afterward, a journalist captured footage of what appeared to be a sewage spill at a base where U.N. peacekeepers from Nepal were living, upstream of where the first cholera cases had been reported, according to a report compiled by Yale Law School programs and a Haitian nonprofit.

Soon the Praecipio team confirmed there had been a cholera outbreak in Kathmandu, prompting them to post online what were then merely suspicions that the outbreak in Haiti had been transmitted by the Nepalese peacekeepers.

Wilson said his group was one of the first to reach the conclusions that would become an international scandal.

“The role that we played was simply this: That we had plausible evidence pointing to that base,” he said.

Wilson credited Nepal for taking the investigation into the outbreak seriously but criticized the United Nations for denying responsibility in the matter for so long.

“The U.N. fundamentally should be held accountable,” he said.

He also has urged the U.N. to put measures in place to ensure peacekeepers’ nations have not recently been exposed to infectious diseases, especially as the world deals with outbreaks of Dengue fever and Zika virus disease.

“These are the kind of risk analyses that are going to have to be done from now on,” he said.

The Department of Homeland Security’s National Biosurveillance Integration Center (NBIC) was created in the wake of the 2001 Amerithrax attacks, 9/11 attacks on the World Trade Center and the Pentagon, Severe Acute Respiratory Syndrome (SARS), and global emergence of influenza A/H5N1. NBIC’s creation also followed the National Intelligence Council’s 2000 Estimate that highlighted infectious disease as a national security issue for the first time in U.S. history. The Trump Administration’s National Security Strategy of the United States of America, released in December 2017, emphasized biological threats as a leading national security concern.

The original premise in the National Intelligence Council’s 2000 Estimate — that biothreats may be naturally, accidentally, or intentionally caused — was a novel concept at the time, where the majority of the traditionally minded national security professionals focused on intentional acts. The classic definition of intelligence was the standard: "Intelligence is the collecting and processing of that information about foreign countries and their agents which is needed by a government for its foreign policy and for national security, the conduct of non-attributable activities abroad to facilitate the implementation of foreign policy, and the protection of both process and product, as well as persons and organizations concerned with these, against unauthorized disclosure."

Intelligence related to biothreats was viewed as a difficult-to-define non-traditional exception to this definition. There was a bias towards intelligence and detection technologies focused on human actors’ intent to weaponize biological agents. However, history had shown that naturally occurring biothreats such as the threat of a 1918-like influenza pandemic could catch the United States by surprise and result in more loss of life than all of the modern examples of biological weapon deployments combined. The 2009 H1N1 influenza pandemic, Middle East Respiratory Syndrome (MERS) crisis, West Africa Ebola disaster, and Zika crisis affirmed this point as well as reveal serious issues with timely warning and the need for accurate and balanced threat assessments. The United States continues to exhibit delayed recognition and warning of these difficult-to-predict biothreats and is highly reactive in its response. Worse, these shortfalls are continually broadcast publicly to those who may seek to do us harm. In summary, our nation still does not have an effective warning system for biothreats associated with national security implications.

The core issue that has always faced NBIC is the acquisition of enough information to generate a warning message early enough in the evolution of a biothreat to enable more proactive response and hence, promote local community resilience. Biothreats often appear without diagnostic clarity: we do not know what pathogen is involved, whether we are dealing with a previously unknown pathogen, or whether it is a well-known pathogen that has mutated. Even more concerning, attribution is often not known until weeks, months, or years later. Time-sensitive resolution of uncertainty is a critical prerequisite for generating a well-considered response. Unfortunately, these threats are often associated with tremendous delays in recognition and bureaucratic hesitation to discuss uncertainty with the public. The result is unbalanced threat assessments and highly reactive response. Our local responders and citizens are the ones who receive the brunt of this failure.

As far as the United States is concerned, the feared coming apocalypse of Ebola, biological weapon, or accident of biotechnology “run amuck” has not been seen. One might surmise that either we are overblowing this threat, simply lucky, or something in-between. What we have seen are ongoing examples of socio-economic disruption and periodic distraction of our country’s top officials when these crises and disasters have appeared. The issue at-hand is having an appropriate system of assessing risk and communicating that risk in a well-considered, balanced manner without the need to generate hype.

We are concerned to hear recently that NBIC is being considered for programmatic cancellation by the newly formed Combatting Weapons of Mass Destruction Directorate of DHS. We are even more concerned given we have, for several years now beginning with the Obama Administration, witnessed a dramatic scaling back of biointelligence assets and capabilities that leave our nation without the technical advantage we once had. We estimate we are now 20 years behind where we were at the start of the first term of Obama’s presidency. At worse, we have provided (and continue to provide) robust demonstration to our adversaries that we are unorganized, undecided, and woefully ill-prepared.

There is little disagreement the NBIC program has been troubled from its initiation, however, our nation’s continued neglect of this intelligence space will not simply wish it away. The gaps in intelligence continue to widen, and the support we are supposed to provide our already-strained healthcare, veterinary, and crop infrastructure is simply not adequate. One decision is certainly to cancel the program and perhaps attempt a reboot under another agency. However, it is fair to say it is unlikely we will see a reboot attempt until our nation experiences a direct hit from one of these national security-level biothreats.

A more productive, alternative path would be to convene a transparent public hearing on NBIC before Congress, where all of the prior Directors and Chiefs of Operations present their perspectives regarding the challenges and most importantly, potential solutions that will truly enable a full realization of the mission we had all envisioned for NBIC and our country. The program requires a complete review of its current mission and vision, operations, product output, and relationships with its partner agencies. The review must include an unbiased view of the current “value-add” of NBIC’s products and whether those products are addressing this country’s critical need for an effective warning system for biothreats. NBIC requires an Advisory Board and guidance from experienced operations personnel. It also requires strong, results-oriented action from DHS’ senior leadership, the Homeland Security Council, accompanied by White House-backed coordination (as highlighted by the Biodefense Blue Ribbon Panel and now by President Trump’s proposed National Security Strategy).

Without these constructive changes, the United States will continue to be surprised by biological threats and continue to be reactive in response. And someday our country may see our luck run out. [...]

• Dr. Wilson was the first operations chief of the Department of Homeland Security’s National Biosurveillance Integration Center and worked with the Intelligence Community during the birth of formal health security intelligence in the mid-2000s. Dr. Wilson led the private intelligence teams that provided warning of the 2009 H1N1 influenza pandemic, discovery of the United Nations as the source of the 2010 cholera disaster in Haiti, and several investigations of alleged and confirmed biological weapon deployments. He is currently the Director of the Nevada Medical Intelligence Center in the School of Community Health Sciences and a practicing pediatrician in the Department of Pediatrics at the University of Nevada, Reno

• Prior to moving to the private sector in 2008, Dr. Smith was the Senior Advisor for International Biodefense for the Department of Homeland Security (DHS), Office of Health Affairs.  While in this position he served as a detailee to the Office of International Health & Biodefense of the U.S. State Department.  In his tenure at State, Dr. Smith served as a subject matter expert working with international partners to promote coordinated biodefense and emergency response strategies and to open dialogues on food and agricultural security and safety.  Dr. Smith’s responsibilities at DHS included serving as the Acting Director of the National Biosurveillance Integration Center and in 2005, Dr. Smith was named as the first Chief Veterinarian for DHS and Chief Scientist for the Office of Health Affairs. He is currently Executive Vice President and Chief Science Officer for Excite-PCR, a biotechnology company based in Pleasanton, California.

• The first question that needs to be asked is, “What true difference in response would declaration of a PHEIC bring that is not already happening?”

• The second question, which should have been answered transparently months ago is, where is the data on vaccine effectiveness? We aren’t talking about the studies from West Africa but what is going in the DRC. WHO has ignored multiple requests, and that issue is not going away. The Ugandans, Rwandans, and Sudanese are counting on that vaccine actually working as advertised. And the healthcare systems of Europe and US have an expectation that requires proactive management. Meanwhile we still have reports of healthcare workers dying without indication of whether they were vaccinated.

• Bottom line: unless you have evidence of uncontrolled expansion to Uganda, Rwanda, or Sudan and within proximity of an international airport, you are going to have a hard time justifying global emergency relevance. Beware of media hype when trying to form a balanced assessment.

• James M Wilson V, MD FAAP

• Director, Nevada Medical Intelligence Center , University of Nevada-Reno

The mysterious and growing cluster of unexplained pneumonia cases in the Chinese city of Wuhan has infectious disease experts parsing limited public statements from Chinese authorities for clues to what is happening.

With machine-translated reports that the outbreak might be caused by a new virus, and perhaps even a new coronavirus — the family of viruses that produced both SARS and MERS — watchers are hoping that Chinese authorities will provide additional information soon.

“I think we need to give them a couple of days but I want to hear something from a credible source on the investigations that are ongoing,” said [Dr. Marion Petronella Gerarda Koopmans (born 1956)], director of the department of virology at Erasmus Medical Center in Rotterdam, the Netherlands.

As of Friday, health authorities in Wuhan reported 44 cases, a big jump from the 27 reported on Tuesday. Eleven of the 44 were seriously ill, the Wuhan Municipal Health Commission said, though there were no reported deaths to date. The health of 121 close contacts of the cases was being monitored. The infections are linked to a large seafood market where it is believed some exotic animals were also sold for consumption.

The World Health Organization has said little about the outbreak beyond that it is in close contact with China authorities on the issue.

“We’re closely monitoring the situation in Wuhan and are in active communication with our counterparts in China,” WHO’s regional office for the Western Pacific Region, which includes China, said on Twitter. “We’ve activated our incident management system across the three levels of WHO (country office, regional office, HQ) and can launch a broader response, if needed.”

The hypothetical outbreak, which has been nicknamed ‘Disease X’ by the World Health Organisation (WHO), could erupt unexpectedly, scientists have warned. And with a mysterious disease affecting tens of people in China, some experts fear the worst. The illness, a pneumonia of unknown origin, was first reported on New Year’s Eve in Wuhan City in Hubei Province.

As of January 3, a total of 59 patients have been reported to the World Health Organization (WHO) by the national authorities in China.

Experts have ruled out another outbreak of Severe Acute Respiratory Syndrome (SARS) which infected about 8,000 people in 2003, leaving researchers stumped.

Gauden Galea, the WHO Representative to China, said: “Further investigations are required to determine the source, modes of transmission.”

James Wilson, a paediatrician who has helped monitor health security threats for 25 years, told Business Times: “Disease X is one of the key health security risks in today’s world, and a priority for global monitoring.”

The hypothesised Disease X has the potential to creep up on humanity and wipe out large swathes of the population in a similar fashion to the Spanish Flu, which killed off five percent of the global population, and Russian Flu, which wiped out a million Europeans.

Last year, WHO declared Disease X is one of the great potential risks to life and a top priority for research.

Scientists have made strides in trying to uncover the unknown and discovered two new viruses in Myanmarese bats.

The viruses which were discovered belonged to the coronavirus family which have already caused two outbreaks on Earth.

One is SARS while the other is the Middle East Respiratory Syndrome (MERS) which has a 35 percent mortality rate and was first identified in 2012.

Marc Valitutto, a wildlife vet with Smithsonian Conservation Biology Institute’s Global Health Program, said: “Our goal is to look for a pandemic virus, a virus that has the potential to have high mortality.”

He adds that the next diseases will likely come from Asia or Africa as these are the places where humans are most rapidly destroying the environment. He said: “We are seeing once pristine forests under threat for increased development, which brings wildlife in these areas in close contact with humans.

Text : [HM005J][GDrive] :

"Medical workers at the epicenter of the coronavirus outbreak say overwhelmed services and a dearth of protective equipment are putting them at risk of the infection, which claimed the life Friday of the heroic doctor chastised for warning about the SARS-like virus.

A respiratory physician working at Renmin Hospital, in the central Chinese city of Wuhan, took to Weibo and other social media in the past week to post videos and comments about his illness, which he said, came close to killing him. His wife caught the so-called 2019-nCoV virus while she was caring for him in a hospital lacking front-line health workers, he said.

China is bolstering medical support, especially intensive care unit nurses, the government’s National Health Commission said Friday. Reports circulated on social media earlier in the week showing the Wuhan virus was transmitted among 15 or more patients and staff in 13 of the city’s hospitals. Dozens were infected in four weeks at one hospital alone, according to a study published Friday.

"It appears that the involved hospital had a serious challenge with infection control,” said James M. Wilson, a former chief of operations with the Department of Homeland Security’s National Biosurveillance Integration Center, in a text message Saturday.

Wilson, a pediatrician who has monitored health-security threats for 25 years, said he’s gauging the severity of the epidemic by how well ICUs cope. So far, he’s not seen any reports of them collapsing, he said.

Almost 35,000 cases have been reported in more than two dozen countries. Wuhan accounts for more than a third.

About 82% of cases are mild, 15% are severe and 3% are critical, the World Health Organization told reporters during a briefing Friday. Of the more than 700 fatal cases, most have been in older patients and those with underlying medical conditions such as diabetes and hypertension.

Disease trackers are focusing on the spread of 2019-nCoV in hospitals because they were implicated in the amplification and spread of the coronaviruses that cause both severe acute respiratory syndrome, or SARS, and Middle East respiratory syndrome, or MERS, during the past two decades.

Most infections are occurring in the community, with health-care workers making up less than 10% of cases, Benjamin Cowling, head of epidemiology and biostatistics at the University of Hong Kong, told a forum on the new coronavirus at Melbourne’s Peter Doherty Institute for Infection and Immunity on Thursday. That compares with about 25% in SARS and MERS cases, according to Cowling, who assisted the Chinese CDC last month with analyses of transmission dynamics. [...] "

In recent days, Europe has become the epicenter of coronavirus disease 2019 (COVID-19). Soaring case fatality rates across European states, disparate public health and global health security response across borders, baseline health-care infrastructure differences, and significant social, economic, and political influences on key decision-making all exacerbate the challenges of this acute crisis. As Europe moves into acute disaster response mode, a unified, oriented, and evidence-based crisis command must be established that goes beyond the established border measures taken and the European Union (EU) export scheme for protective equipment. We propose in this letter the EU mechanism for crisis managed response cycle be initiated immediately to mitigate preventable morbidity and mortality from coronavirus disease 2019 (COVID-19), which includes the North Atlantic Treaty Organization (NATO) and military alliance involvement.

Complete and comprehensive peer reviewed data related to morbidity and mortality for COVID-19 may not be available for many months and likely years. However, public health measures to flatten the curve of case fatality rates differ widely across the affected states and communities. In a maximal effort to defend civilian populations, communities, and regions, self-isolation, social distancing, multiple versions of quarantine, and even full lock downs have been instituted or considered in varying forms; some states may institute Martial Law. Social, economic, and political infrastructure are greatly tested across the EU, and health security once again demonstrates that disease observes no borders or passport color. Indeed, economic stress will come to a breaking point and confidence in European public health and democratic institutions will be greatly challenged; especially as we observe different responses, by individual countries, in the same union against the same coronavirus threat.

The EU Global Strategy points out that the EU is more and more facing hybrid forms of threats, and COVID19 tops the list today. However, the EU struggles to have a unified and integrated civil-military approach to public health crisis, disaster, and disease pandemic that is desperately needed immediately. The European Centre for Disease Prevention and Control (ECDC), an independent agency of the EU whose mission is to strengthen Europe’s defenses against infectious diseases, is closely monitoring the pandemic, providing risk assessments, public health guidance, and advice on response activities to EU Member States and the EU Commission. Within the domain of Civilian-Military interoperability, NATO, with locations throughout Europe, has multiple structures responding separately. The Force Health Protection Branch of the NATO Military Medical Center for Excellence (MILMED COE) is closely monitoring the developments. There are many NATO resources that can additionally be tapped to support the response. Health security intelligence, information sharing, and leadership with command decisions for the EU are completely absent.

Luckily, the EU has an application for that. The Council, or when an EU member state triggers the solidarity clause, can activate the EU Integrated Political Crisis Response Mechanism (IPCR); also referred to as the Crisis Platform, EU Situation Room, Crisis Management Board. This mechanism plays a central role in ensuring both swift and effective mobilization of actors and instruments across the entire EU system, as well as coherence of policies and actions throughout the various phases of the crisis life cycle. The Croatian presidency activated the IPCR in information sharing mode in January 2020 and triggered full activation mode on March 2, 2020.

However, in triggering this mechanism to its full extent, military and civilian resources, including the EU civil protection mechanism, will be liberated and under full command and direction from the Council and the European External Action Service (EEAS); multiple committees and commissioners and military staff would be forced to the table to respond in a unified voice. Full activation mode includes a united and clear structure for response and decision-making, de facto solidarity across the EU for crisis response. Beyond the integrated political crisis response mechanism as it is designed today, the EU, currently still including the United Kingdom, urgently requires a practical tool to analyze and fully apprehend the nexus between the different civilian and military (security and logistic) components of a crisis and disaster, as well as the determinant of the health/wealth concept that bound health systems to the political and economic dimensions of the EU.

As more data become available about case vitality rates, transmissibility, and overall natural history of disease for COVID19, the requirement to maximize information sharing on genomic, clinical, and outcomes will become more apparent. Triggering this crisis mechanism may also lead to further information sharing across platforms, public health infrastructure, socialized medical systems, and integrated with defense health structures. The time for action is now. The time for open and unified policy of how best to mitigate disease spread is required now. In order to provide economic, social, and political unity and confidence in democratic institutions of the EU, this must be done now.

Expansive coordination is essential for the EU, for the sake of both the individual nation states and the collective community. The model is applicable, however, beyond the boundaries of the EU. COVID19 is a global challenge, which mandates a global response. The precise coordinative mechanisms may vary, depending on national law and tradition, but the need for unity of effort has never been greater. Failure in this regard would exact a price, measured by the cost of millions of lives.

Introduction

• The West Nile virus epidemic in the Americas that spread coast to coast from 1999 to 2002 produced 48,183 documented cases and 2,163 fatalities (4.5%) across the United States by 2017 and gained permanent ecological establishment.1 The epidemic was the largest of its kind in the history of the western hemisphere.2 West Nile disease is caused by a mosquito-borne virus that, in a minority of typically older patients, causes encephalitis (brain infection) and other neurological problems such as paralysis, and death. The virus is capable of infecting multiple species of animals, including birds, horses, and reptiles. The crisis represented a ‘virgin soil’ epidemic, where a pathogen exotic to the receiving geographic area was introduced to an ecosystem that did not have appreciable levels of herd immunity. Herd immunity refers to the number of host individuals, across multiple species, that have protective immunity thanks to prior exposure to the pathogen. The impact of morbidity and mortality due to a given infectious disease is mitigated by the level of herd immunity, where lack of herd immunity implies the potential for explosive transmission and higher severity of illness.3
• The arrival of West Nile in the United States was initially recognized as an outbreak of bird die-offs and human encephalitis in New York City. The outbreak was eventually recognized as a prioritized warning signal through a complex, months-long, drawn-out pattern of siloed communications among disparate professional groups. Because of the unusual epidemiological and clinical presentation, discovery of a virus that did not morphologically match known endemic viruses, and recent social sensitization to the threat of biological terrorism, the situation was treated as a potential security threat.4
• This case study reviews the sequence of warning intelligence failures that contributed to delayed recognition, threat assessment, and loss of potential opportunity to mitigate the impact of this introduced exotic pathogen.

Materials and methods

• The authors utilized their own personal notes, government reports,5 and the narrative timeline compiled by Drexler (2003) to reconstruct the sequence of awareness among the organizations involved with alert and verification of the initial New York City outbreak of West Nile virus. For the media signal analysis, keyword queries were used for a media source local to New York City, the Daily News, to extract the number of references in an online curated newspaper archive, Newspapers.com.6
• Days of the crisis were numbered based on the first day of the month of first awareness, June 1999. To reconstruct preceding events in Europe and the Middle East, a review of peer-reviewed academic literature was conducted in the National Library of Medicine’s PubMed.7 To evaluate air traffic data between the Middle East and the United States, data were analyzed from the US Department of Transportation Bureau of Transportation Statistics.8

Results

• In the summer of 1996, an unusual epidemic of West Nile virus was reported in Romania, where officials from the US Centers for Disease Control and Prevention were invited to assist with the investigation.9 It was believed to be the first documented large-scale epidemic in Europe involving human patients. Nearly 400 human patients were identified with 17 deaths and evidence of virus in local mosquito and bird populations. In the subsequent years, West Nile virus was found to have spread regionally, with additional human cases in the Czech Republic in 1997 and identification in horses in Italy and a large epidemic involving swans in Israel in 1998.10 The swans in Israel were believed to have picked up the virus during their seasonal migration from West Nile-infected areas of Europe.11 Overall, it appeared there was a new wave of virus transmission in Europe- an evolution of West Nile introduction to Europe since the 1960s from Africa, where it was previously endemic.
• In June 1999, a private veterinary clinic in Bayside, Queens, New York City evaluated wild crows brought to the facility by local community citizens who were concerned the birds were acting strangely.12 There was no indication the clinic was able to diagnose the disease or environmental exposure responsible. These cases of wildlife disease were not reported to local health authorities.
• In early August, the New York State Department of Environmental Conservation (NYSDEC) received reports of bird die-offs involving crows in New York City parks. The NYSDEC was the state agency responsible for wildlife disease evaluation.13 On August 9th (Day 69), dead wild crows were discovered outside the Queens Zoo property and reported to one of the authors (McNamara).
• McNamara served as the head veterinary pathologist for the parent organization for the Queens and Bronx Zoos as well as three additional zoos in the New York City area. McNamara, noting dead crows as well at the Bronx Zoo submitted samples to the NYSDEC. On August 12th, a report of no diagnosis was returned to the curator of the Queens Zoo. This caused consternation among the zoo’s leadership due to the potential for an unknown disease to cause illness and death among both zoos’ collections of exotic birds. Three days later, the first human patient was admitted to Flushing Hospital, Queens with undiagnosed, severe illness.14
• On August 17th, the NYSDEC wildlife pathologist examines crow specimens however is unable to diagnose what killed them. On August 19th, McNamara was notified the Bronx Zoo samples also returned a result of no diagnosis. The NYSDEC wildlife pathologist was receiving many dead bird specimens, according to the local media the same day. On approximately August 20th, a Bayside, Queens local neighborhood newspaper reported crow die-offs, asking if ‘. . .a plague hit the Bayside area?’15
• On August 23rd (Day 83), an infectious disease physician at Flushing Hospital notified local public health officials of two unusual cases of encephalitis and paralysis that were admitted to the intensive care unit. This included the patient admitted on August 12th.16 Simultaneously, McNamara sent brain tissue samples from dead wild crows to the New York Department of Environmental Conservation. McNamara was not satisfied with the lack of diagnosis and began her own investigation. Her review of the samples in her laboratory indicated the presence of a possible viral encephalitis to explain the crow deaths.
• Two more cases of encephalitis were admitted to the Flushing Hospital intensive care unit and two additional cases were admitted to another local hospital on August 27th. This was an unusual volume of encephalitis cases. The next day, local public health authorities arrived at Flushing Hospital while a fifth case was admitted. On August 29th (Day 89), local public health officials notified the US Centers for Disease Control and Prevention as an emergency communication. Two days later, Saint Louis Encephalitis (SLE) virus was identified in samples from the Flushing Hospital patients at a local New York public health laboratory; these samples were shipped to the CDC arbovirus laboratory in Fort Collins, Colorado for verification.17 SLE virus is a known, endemic mosquito-borne virus in the United States. Paralysis was not previously reported for endemic SLE infections in the United States. Prior seasons of SLE transmission in the United States began in the southern states with northward progression versus initial appearance in northern states. The southern warning signal did not precede this crisis.18
• On September 3 (Day 94), New York City local public health were notified by CDC-Fort Collins of a confirmed diagnosis of SLE virus and initiated mosquito spraying. City officials communicated with the Federal Bureau of Investigation to report a possible act of biological terrorism. The next day (see Figure 1), local public health officials began speculation about a link between the bird die-offs and human cases. At this point, McNamara became aware of local news media attention on an unusual encephalitis outbreak involving human patients.19
• McNamara called CDC-Fort Collins on September 9th (Day 100) with concerns the SLE diagnosis did not fit the epidemiological pattern she was seeing- a bird die-off. This was in the context of increased zoo employee anxiety about their risk of exposure to disease still killing the exotic bird population. SLE transmission did not cause bird die-offs based on prior experience with the virus in the US. Other viral avian diseases such as highly pathogenic avian influenza and Newcastle disease would have killed the zoo’s chickens in the petting zoo area, and Eastern equine encephalitis would have killed the emus present in the park. These avian populations were spared, highlighting another epidemiological and clinical pattern that did not fit the initial SLE diagnosis. These birds would have served as sentinels for known causes of encephalitis in birds in the western hemisphere. The observation they were not dying indicated the possibility of a novel, previously unrecognized veterinary pathogen.
• McNamara relayed concern that one of the Bronx veterinarians had accidentally stuck themselves with a needle while euthanizing a symptomatic flamingo. McNamara was advised that CDC did not process samples from animal species and did not share McNamara’s concern that the epidemiological pattern did not make sense. McNamara proceeded to send samples to the National Veterinary Services Laboratory at the US Department of Agriculture in Ames, Iowa. Two days later, the National Veterinary Services Laboratory called McNamara to report the avian samples were positive for a flavivirus, but no additional specific identification information was available. This was an unprecedented laboratory finding from the veterinary perspective- no flavivirus had been known to cause animal disease in the western hemisphere. The flavivirus family includes dengue, yellow fever, SLE, and West Nile virus species. McNamara notified CDC-Fort Collins, again emphasizing the pattern of transmission may not be SLE virus. The National Veterinary Services Laboratory forwards McNamara’s samples to CDC for further testing.
• In the third week of September, the Connecticut Agriculture Experimental Station identified flavivirus in both crow and mosquito samples, unbeknownst to McNamara. On September 21st, McNamara spoke with the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID) at Fort Detrick, Maryland and sent them samples. USAMRIID confirmed flavivirus in McNamara’s samples and ruled out SLE virus on September 22nd (Day 113). That same day, CDC-Fort Collins identified flavivirus virus from McNamara’s samples that were sent two weeks previously to the National Veterinary Services Laboratory. The last known West Nile-positive human patient was ill also on September 22nd. On the next day, an academic researcher, Ian Lipkin, identified flavivirus from New York City human brain samples and communicated that finding to the New York State Department of Health. CDC-Fort Collins retested human samples and revised their diagnosis to West Nile virus.20
• On September 24th, Lipkin informed the NYSDEC the virus genetic sequences most closely matched Kunjin or West Nile virus. That same day, CDC notified the New York State Department of Health the bird samples were positive for West Nile, and Lipkin discovered positive West Nile virus genetic sequences in human samples. The next day (Day 115), the media reported the presence of West Nile in New York City’s birds.21
• The New York City media reporting signal began on September 4th (Day 95), with a report of an outbreak of St. Louis encephalitis (Figure 1). The transition in terminology to West Nile occurred on September 25th (Day 115), which was the day of first mention of crow die-offs in the media source used for this study. Human illness was reported before bird die-offs and to a more robust degree. The media signal was approximately three months from local community notation of the first indicators of crow deaths in June. The online newspaper archive used for this study, which reported on New York City writ large, did not make note of the local Queens community paper’s report of an unusual outbreak of disease in crows in late August 23.22
• Data from the Bureau of Transportation Statistics acquired in 2003 by one of the authors (Wilson) indicated the leading source of air traffic from the Middle East to New York City and Newark, New Jersey in 1999 was Israel, which seasonally peaked in August (Figure 2). There were, on average, 50,700 passengers that traveled between New York City and Israel in 1999.23 The Bureau indicated to Wilson no public health official had asked for air traffic data – that this was the first time to their recollection any public health official had asked for such data for any outbreak investigation. In 2001, the origin of the epidemic was reported to be Israel.24 The mechanism of virus translocation to the United States, whether importation of infected mosquitoes or human passengers, was not proven.

Discussion

• This case study highlights the challenges of integrating and maintaining a system of strategic health security warning intelligence with near-real time local warning communications. Unfortunately, reports of unusual West Nile activity in Europe did not result in a focus on preparedness in the United States. Connectivity between unusual West Nile activity in swans in Israel was not reported until years after the epidemic in New York City, and the air traffic connections between the United States and Israel were not known at the time. This information might have enabled focused warning communication to New York City and proactive preparedness activities such as mosquito spraying at the airports and education of veterinarians and healthcare clinicians. It is unknown whether proactive mosquito spraying at the airports would have stopped translocation of the virus to the western hemisphere. Israel did not have an established surveillance system for West Nile and thus was not a reportable human disease- this was created after the well-publicized New York epidemic. In 2001, Israel mandated reporting of West Nile infections in humans.25
• Delays in unusual disease signal recognition result in delays in public health engagement, whether those signals appear in animals or in humans. It is arguable that, had McNamara not pushed for recognition of an animal signal that appeared at the same time as a human signal, the world would have drawn the conclusion that the New York epidemic was due to a routine mosquito-borne virus, Saint Louis encephalitis (SLE). McNamara did not know of the human signal until it was announced by the media on September 3rd, which highlights a missed potential opportunity of connecting the bird die-offs with human cases two weeks prior. There were important differences in threat assessment of a known, endemic disease (SLE) for which there was a given baseline of herd immunity versus an exotic disease (West Nile) where there was little to no herd immunity. Epidemics involving known, endemic disease implies routine public health response. Alternatively, virgin soil epidemics imply emergency response and potential for threat to national security. These situations suggest involvement of agencies involved with national defense or attribution investigation if there is suspicion of biological terrorism. Regardless of etiology, virgin soil epidemics are also often associated with greater socio-economic disruption to the involved communities than epidemics involving routine, locally familiar disease.
• The critical role of the astute clinician-observer was highlighted in this case study with the involvement of the infectious disease physician at Flushing Hospital and McNamara at the Bronx Zoo. Had the local veterinarian in Bayside, Queens reported the apparent outbreak of unusual disease in crows in June, they too would have represented another astute observer. The presence of astute observers does not fully solve the challenge of recognition; however, the first known human case was missed, an unrecognized case that presented on August 2nd.26 This highlights the value of experienced observers well trained in considering both routine and non-routine diseases among their patients. It also highlights the value of education and training in the recognition of rare diseases and pathogens of concern for potential use as potential biological weapons.
• There were multiple community organizations, professional disciplines, and associated governmental agencies that exhibited siloed communication that interfered with timely recognition of the threat signal. These groups included: human health clinicians; community and exotic animal veterinarians; diagnostic laboratories including both veterinary and human health and spanning both military and civilian agencies; community special interest groups (i.e., in Queens that brought crows to the veterinary clinic); and public health authorities.
• We estimated there were at least nine separate groups of people that together contributed to the final recognition and diagnosis of West Nile virus during this epidemic, of which two astute observers played key roles in initiating the warning sequence of communication. There was evidence of bias at CDC when they believed SLE virus was initially responsible for the epidemic, and when questioned about their belief exhibited resistance to the presentation of competing hypotheses relating to discrepancies in epidemiological and clinical patterns of disease relating to both the avian and human cases.
• There was evidence of bias in social sensitivity that ultimately prioritized public orientation to a threat signal and mount organized, emergency response. The driver for public health engagement was report of human versus animal disease. It is debatable whether public health would, or politically could, have engaged in response with report of a possible outbreak of disease in crows in June – unless a flavivirus unknown to the western hemisphere could have been diagnosed in June. This implies caution when considering research demonstrating the appearance of high threat infectious disease in animals preceding appearance in humans. Public perception and reaction to that perception may be focused on human disease as validation of threat, which highlights the challenges of integrating veterinary and human health disease surveillance to produce effective warning communication in health security.
• There is caution in the use of open-source intelligence for warning signals related to health security threats. Warning signals associated with health security crises are often associated with significant delays in public communication. These delays are typically related to lack of local familiarity with the pathogen in question and therefore no prior investment in a specific, established public health surveillance system for the given pathogen.
• Currently, the American system of biological threat warning does not include a robust wildlife diagnostic surveillance component. In addition, animal sentinels found in crowded urban centers like dogs, cats, and shelter animals and zoological collections do not fall under the jurisdiction of any federal agency and therefore are not currently under any formal surveillance. Should a similar warning signal appear in these sentinels, it is possible they would be missed. Even if this component existed, there remain significant communication defects between the veterinary and human health communities and the federal and private sectors.
• As with other health security crises, there is often no available pharmaceutical countermeasure to mitigate impact. As of the date of this writing, there is no FDA-approved human vaccine for West Nile virus, nor is there an approved anti-viral. Education and mosquito control remain the mainstays of impact mitigation, which emphasizes the importance of early warning to prompt non-pharmaceutical countermeasures. Regardless of concerns about attribution, early warning coupled to proactive preparedness and response is crucial to mitigate the effects of health security threats.

Notes

1. 1. Centers for Disease Control and Prevention, “West Nile Virus.”
2. 2. Centers for Disease Control and Prevention, “Provisional Surveillance Summary.”
3. 3. Crosby, “Virgin Soil Epidemics.”
4. 4. U.S. Government Accountability Office, “West Nile Virus Outbreak.”
5. 5. Ibid.
6. 6. Newspapers.com.
7. 7. PubMed.gov.
8. 8. Bureau of Transportation Statistics, “Air Carriers.”
9. 9. Tsai et al., “West Nile Encephalitis.”
10. 10. Hubálek and Halouzka, “West Nile fever”; Hubálek, Halouzka, and Juricová, “West Nile fever”; and Giladi et al. “West Nile Encephalitis.”
11. 11. Malkinson et al., “Introduction of West Nile.”
12. 12. Drexler, Secret Agents, 32.
13. 13. See note 5 above.
14. 14. Ibid; and Drexler, Secret Agents, 20.
15. 15. See note 5 above.
16. 16. Drexler, Secret Agents, 20.
17. 17. See note 5 above.
18. 18. Drexler, Secret Agents, 56.
19. 19. See note 5 above.
20. 20. Ibid.
21. 21. Ibid.
22. 22. See note 7 above.
23. 23. See note 9 above.
24. 24. Giladi et al., “West Nile Encephalitis.”
25. 25. Ibid.
26. 26. See note 5 above.

Acknowledgements

• The authors gratefully acknowledge the manuscript reviewers for their comments.

Disclosure statement

• Dr. Wilson is employed by M2 Medical Intelligence.

Notes on contributors

• Tracey McNamara, D.V.M., Diplomate, A.C.V.P., NAPf is a veterinary pathologist and a Professor of Pathology at Western University of Health Sciences College of Veterinary Medicine in Pomona, CA. Dr. McNamara specializes in the recognition and understanding of the diseases of captive and free-ranging wildlife and is best known for her work on West Nile virus. Dr. McNamara served as a consultant to the National Biosurveillance Advisory Subcommittee and continues to be actively involved in the development of the Nation’s biosurveillance strategy. She served as lead on a project with Russian colleagues on the ‘Human-Animal Interface’ by the Nuclear Threat Initiative’s Global Health and Biosecurity program in Wash. DC. She recently gave a TEDxUCLA talk entitled ‘Canaries in the Coalmine’ about continued gaps in biosurveillance for emerging biological threats. She is a founding member of the Global Health Security Alliance (GloHSA) group established by the German government in 2017. Most recently, she participated in Ending Pandemics ‘Finding Outbreaks Faster – Metrics for One Health Surveillance’ at the Salzburg Global Seminar in Austria and is now a Salzburg Global Seminar Fellow. She is actively involved in the One Health movement and advocates for a species neutral approach to the detection of pandemic threats.
• James M. Wilson is the CEO of M2 Medical Intelligence, Inc. Dr. Wilson is a board-certified, practicing pediatrician who specializes in operational health security intelligence, with a focus on the anticipation, detection, and warning of infectious disease crises. Dr. Wilson led the private intelligence teams that provided tracking of H5N1 avian influenza as it spread from Asia to Europe and Africa, detection of vaccine drifted H3N2 influenza in 2007, warning of the 2009 H1N1 influenza pandemic, discovery of the United Nations as the source of the 2010 cholera disaster in Haiti, and several investigations of alleged and confirmed laboratory accidents and biological weapon deployments. Dr. Wilson is a strong advocate for effective and accountable global health security intelligence and the need for credible and balanced threat assessments.