OMG do they know?!
Friday, October 18, 2019
8:45 a.m. – 12:30 p.m.
The Pierre hotel
New York, NY
Event 201 was a 3.5-hour pandemic tabletop exercise that simulated a series of dramatic, scenario-based facilitated discussions, confronting difficult, true-to-life dilemmas associated with response to a hypothetical, but scientifically plausible, pandemic. The next severe pandemic will not only cause great illness and loss of life but could also trigger major cascading economic and societal consequences that could contribute greatly to global impact and suffering. The Event 201 pandemic exercise, conducted on October 18, 2019, vividly demonstrated a number of these important gaps in pandemic preparedness as well as some of the elements of the solutions between the public and private sectors that will be needed to fill them. The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates.
The Event 201 scenario
Event 201 simulates an outbreak of a novel zoonotic coronavirus transmitted from bats to pigs to people that eventually becomes efficiently transmissible from person to person, leading to a severe pandemic. The pathogen and the disease it causes are modeled largely on SARS, but it is more transmissible in the community setting by people with mild symptoms.
The disease starts in pig farms in Brazil, quietly and slowly at first, but then it starts to spread more rapidly in healthcare settings. When it starts to spread efficiently from person to person in the low-income, densely packed neighborhoods of some of the megacities in South America, the epidemic explodes. It is first exported by air travel to Portugal, the United States, and China and then to many other countries. Although at first some countries are able to control it, it continues to spread and be reintroduced, and eventually no country can maintain control.
There is no possibility of a vaccine being available in the first year. There is a fictional antiviral drug that can help the sick but not significantly limit spread of the disease.
Since the whole human population is susceptible, during the initial months of the pandemic, the cumulative number of cases increases exponentially, doubling every week. And as the cases and deaths accumulate, the economic and societal consequences become increasingly severe.
The scenario ends at the 18-month point, with 65 million deaths. The pandemic is beginning to slow due to the decreasing number of susceptible people. The pandemic will continue at some rate until there is an effective vaccine or until 80-90 % of the global population has been exposed. From that point on, it is likely to be an endemic childhood disease.
Highlights Reel
Selected moments from the October 18th Event 201 Exercise (Length: ~12 minutes)
Videos of Event 201
These five segments include discussions among high-level leaders of global businesses, governments, policy and public health. (Length ~3 hours)
Segment 1 - Intro and Medical Countermeasures (MCM) Discussion
Segment 2 - Trade & Travel Discussion
Segment 3 - Finance Discussion
Segment 4 - Communications Discussion and Epilogue Video
Segment 5 - Hotwash and Conclusion
God help us all, Zeljko Serdar
CAPS: THE PATHOGEN AND CLINICAL SYNDROME
ReplyDeletePrepared by Amesh Adalja and Lane Warmbrod
The FICTIONAL Coronavirus Acute Pulmonary Syndrome (CAPS) is an acute respiratory
infection that can progress to pneumonia and acute respiratory distress syndrome. It is
caused by a swine-origin coronavirus (CAPS virus).
The CAPS virus is from the same family of viruses as SARS and MERS but is antigenically
distinct. The virus has existed in the fruit bat population for many years and has been
transmitted to domestic pigs. The virus causes mild disease in pigs.
Like SARS and MERS, a mutation in the CAPS virus enabled human infection, leading to one
or more spillover events to pig farmers in South America, but with limited human-tohuman spread. Like SARS, a further mutation in the CAPS virus later enabled efficient
human-to-human transmission.
The CAPS virus is more transmissible in mild cases than SARS-CoV, and spread by mildly
symptomatic individuals is possible. Transmission is via the respiratory route, mostly by
respiratory droplets, with some proportion being airborne during aerosol-generating
medical procedures.
• Approximately 50% of CAPS cases require hospitalization, many of them in an
intensive care unit (ICU).
• The CAPS fatality rate in hospitalized patients is about 14%.
• The overall case fatality rate (CFR) is 7%.
• The average R0 is 1.74.
• The incubation period ranges from 5 to 7 days.
There is no licensed vaccine for any coronavirus, although some are in development for
SARS and MERS. There is no antiviral drug with an indication for coronavirus treatment,
although there are several drugs, including anti-HIV drugs, that might be effective. In this
scenario, there is one FICTIONAL HIV antiviral—extranavir—that may be effective for
treatment or prophylaxis of CAPS.
COMMUNICATION IN A PANDEMIC
ReplyDeletePrepared by Marc Trotochaud and Divya Hosangadi
Effective communication during public health events can be critical to public health
response efforts. Public health messages help inform the public about risks and protective
actions and, done correctly, are a critical component of community engagement and the
buildup of public trust. Yet, true information about public health concerns is increasingly
competing with false messages that can damage public confidence in health interventions
and health authorities. These false messages are often defined as misinformation,
erroneous information shared through various channels, and disinformation, purposefully
spread false or misleading information. The information environment is increasingly made
up of a mix of information coming from web sources and other media, in addition to
historical sources such as print and TV news media. However, the influence of social media
has made the spread of false information even more pernicious.
Over the past 15 years, there has been a global surge in the adoption of social media
technologies. In 2019, 6 social media companies had more than 1 billion active monthly
users.
1 Although originally designed for virtual engagement with personal networks, social
media platforms have grown rapidly to share major roles in the economy and the transfer
of information. According to the Pew Research Center, social media officially outpaced
print newspaper as a source of news among the entire United States population.
2
Furthermore, across countries, regardless of a nation’s socioeconomic status, younger
populations rely even more heavily on social media as a news source.3
Disinformation campaigns are widely recognized in the political world but have been
identified in the public health realm as well. In the fall of 2018, a team of researchers
systematically identified a concerted effort to spread disinformation and discord about
vaccine safety.
4 Public health response efforts for the currently ongoing Ebola outbreak in
the Democratic Republic of the Congo (DRC) have been challenged by disruptive rumors
that have occasionally targeted public health responders.
5,6 Misinformation during a public
health emergency is a particularly concerning threat, because of the time-dependent nature
of outbreak response and the corrosive effect misinformation can have on public trust.
Current solutions to the spread of mis- and disinformation are limited. Social media
platforms have attempted to change their algorithms to limit the spread of false
information and promote correct information, but the problem of misinformation
ReplyDeletecontinues.
7,8 Many misinformation response actions have been developed to be used
against political misinformation and disinformation but may be applied in response to an
epidemic. More than 50 countries globally have taken different government-led actions
that, in theory, aim to combat misinformation.
9 These actions can range from media
literacy campaigns and fact-checking websites to more extreme measures, such as jailing
users for publishing content deemed to be misinformation. In some cases, authorities have
shut down social media sites or the internet entirely.
10-12
However, censoring social media content and denying a population access to the internet
has serious consequences. In addition to ethical considerations, there is mounting evidence
to suggest that there are serious economic consequences to shutting down the internet.
According to the Indian Council for Research on International Economic relations, the
estimated 16,000 hours of international internet shutdown in India resulted in around
US$3 billion in economic losses.
12
Misinformation and disinformation are likely to be serious threats during a public health
emergency. Unfortunately, thus far, there are limited ways to control the propagation of
misinformation, leading to potentially draconian methods to manage this problem.
References
1. Most famous social network sites worldwide as of July 2019, ranked by number of active users
(in millions). Statista. https://www.statista.com/statistics/272014/global-social-networksranked-by-number-of-users/. Accessed October 14, 2019.
2. Shearer E. Social media outpaces print newspapers in the U.S. as a news source. Pew Research
Center Global Attitudes & Trends December 10, 2018. https://www.pewresearch.org/facttank/2018/12/10/social-media-outpaces-print-newspapers-in-the-u-s-as-a-news-source/.
Accessed October 14, 2019.
3. Mitchell A, Simmons K, Matsa KE, Silver L. People in poorer countries just as likely to use social
media for news as those in wealthier countries. Pew Research Center’s Global Attitudes &
Trends January 11, 2018. https://www.pewresearch.org/global/2018/01/11/people-inpoorer-countries-just-as-likely-to-use-social-media-for-news-as-those-in-wealthier-countries/.
Published January 11, 2018. Accessed October 14, 2019.
4. Broniatowski DA, Jamison AM, Qi S, et al. Weaponized health communication: Twitter bots and
Russian trolls amplify the vaccine debate. Am J Public Health 2018;108(10):1378-1384.
5. Hayden S. How misinformation is making it almost impossible to contain the Ebola outbreak in
ReplyDeleteDRC. Time June 20, 2019. https://time.com/5609718/rumors-spread-ebola-drc/. Accessed
October 14, 2019.
6. Fidler DP. Disinformation and disease: social media and the Ebola epidemic in the Democratic
Republic of the Congo. Council on Foreign Relations blog post August 20, 2019.
https://www.cfr.org/blog/disinformation-and-disease-social-media-and-ebola-epidemicdemocratic-republic-congo. Accessed October 14, 2019.
7. Matsakis L. Facebook cracks down on networks of fake pages and groups. WIRED January 23,
2019. https://www.wired.com/story/facebook-pages-misinformation-networks/. Accessed
October 14, 2019.
8. Harvey D, Gasca D. Serving healthy conversation. Twitter blog May 15, 2018.
https://blog.twitter.com/en_us/topics/product/2018/Serving_Healthy_Conversation.html.
Accessed October 14, 2019.
9. Funke D, Flamini D. A guide to anti-misinformation actions around the world. Poynter 2019.
https://www.poynter.org/ifcn/anti-misinformation-actions/. Accessed August 26, 2019.
10. Adebayo B, Mahvunga CS, McKenzie D. Zimbabwe shuts down social media as UN slams military
crackdown. CNN January 19, 2019. https://www.cnn.com/2019/01/18/africa/zimbabwearmy-brutality-allegations/index.html. Accessed October 14, 2019.
11. McCarthy N. Infographic: the countries shutting down the internet the most. Statista
Infographics August 29, 2018. https://www.statista.com/chart/15250/the-number-ofinternet-shutdowns-by-country/. Accessed October 14, 2019.
12. Kathuria R, Kedia M, Varma G, Bagchi K, Sekhani R. The Anatomy of an Internet Blackout:
Measuring the Economic Impact of Internet Shutdowns in India. Indian Council for Research on
International Economic Relations; 2018.
http://icrier.org/pdf/Anatomy_of_an_Internet_Blackout.pdf.
EVENT 201 MODEL
ReplyDeletePrepared by Caitlin Rivers
Date: October 11, 2019
The Event 201 model simulates an outbreak of a moderately transmissible pathogen in a
fully susceptible population. The model is intended to be a realistic representation of how a
novel infectious disease could become a pandemic in the absence of adequate control
measures.
Model Description
We used an ordinary differential equation approach to simulate the Event 201 pandemic. A
graphical depiction of the model structure and a table of the key parameters are available
in the Appendix. The model contains six compartments representing different stages of
infection. Key features of the model include two compartments for individuals infectious in
the community: half develop mild illness (�") and half develop severe illness (�$). Patients
with severe infection either die (�) or recover (�) at rate �. Those with a mild infection
move to the recovered compartment at rate �.
Global Spread
Following the initial spillover event in a large city in South America, 300 of the largest cities
in the world were stochastically seeded with infectious cases to represent disease spread
through international travel. The rate at which new cities were added to the model
accelerates as time progresses, much like the growth of the epidemic itself. The number of
imported cases ranged between 1 and 4 for each city.
The model was run for each individual city in turn. To simulate the stochastic nature of
outbreaks, parameters for each city were randomly selected from realistic distributions.
The force of infection, �, was chosen from a normal distribution calibrated to produce an
overall basic reproduction number of 1.7 (the reproduction number of individual cities
ranged from 1.1 to 2.6). The case fatality risk (CFR) of hospitalized patients was chosen
from a normal distribution with a mean of 14%, reflecting expected variation in the ability
of healthcare systems to provide high quality care when faced with large numbers of
ReplyDeletecritically ill patients. Patients with mild illness have a CFR of 0%, for an overall estimate of
7%.
The case counts reported in the exercise represent infections the severe compartment
exclusively, under the assumption that mild illnesses in the community are less likely to be
captured by surveillance systems. The exercise also reports only on the 300 global and 300
US cities represented in the model. For these reasons, the numbers reported in the scenario
are conservative. However, like all models of this type, a core assumption is that the
trajectory of the outbreak remains continuous. In real outbreaks, the trajectory is
constantly changing in response to a number of factors like collective behavior change,
which tend to slow outbreak growth.
FINANCE IN A PANDEMIC
ReplyDeletePrepared by Richard Bruns
There are several major sources of money that would become available to help respond to
a global catastrophic pandemic.
Pandemic Emergency Financing Facility
The World Bank Group’s Pandemic Emergency Financing Facility (PEF) is a system
designed to respond to specific types of pandemics. It consists of a cash window and an
insurance window.1 The cash window had about $50 million, all of which has been used to
support the response to the ongoing Ebola epidemic in the Democratic Republic of the
Congo.
The insurance window is funded by 2 tranches of catastrophe bonds that pay out under
specified conditions. A coronavirus pandemic would trigger a payout of the Class B notes
after all of the following conditions were met: It kills at least 250 people, lasts at least 12
weeks, has at least 250 new cases in the past 12 weeks, has an increasing average number
of new cases over the past 12 weeks, and kills at least 20 people in a second country. The
payout is based on the number of deaths and the geographic spread of the disease. A
coronavirus pandemic that killed more than 2,500 people would trigger a full payout of the
Class B notes, raising $95 million. It would also trigger a 16.67% payout of the Class A
notes, raising an additional $37.5 million. A full payout of the Class A notes is triggered only
by an influenza pandemic.2
World Bank’s IDA Crisis Response Window
IDA (International Development Association) is the part of the World Bank that gives loans
(called “credits”) to poor countries for development. They meet every 3 years to raise
money and decide how it will be spent. These are called Replenishment meetings. The last
one, the 18th Replenishment, or IDA18, finished in 2016. It raised $75 billion to finance
projects from July 1, 2017, to June 30, 2020. The next meeting in this cycle is October 21-
22, 2019, in Washington, DC.3
Most IDA money is used for long-term development projects, but the Crisis Response
ReplyDeleteWindow (CRW) is a special pool of money devoted to helping countries respond to
disasters. It spent $420 million to fight the 2014-2016 West Africa Ebola epidemic. The
IDA18 replenishment raised $3 billion for crisis response and, as of October 2018, $2.6
billion was still unspent and available for immediate use.4
International Monetary Fund
The IMF has about $1 trillion available to lend.5 However, this is meant to address
temporary issues with a country’s balance of payments and is not intended to be a form of
development aid or response to a health emergency. Lending is usually conditional on
economic policy changes, made after a period of negotiation, and will be made only if the
IMF is confident that it will be repaid.6 Without a significant change in policy, many
countries would not be willing or able to borrow money from the IMF in order to finance a
response to a major pandemic.
National Governments
Total international development aid from governments is about $200 billion per year.7
Although much of this is allocated to specific uses and could not be redirected, some
percentage of it could be made available in a catastrophic pandemic, and/or the total
amount might be increased, if there was sufficient global coordination.
Private Charity
Total international giving by US foundations was about $9 billion in 2015.8 In a severe
pandemic, some of this could be redirected to help the pandemic response.
The total endowment of the top 40 wealthiest charitable foundations is currently about
$500 billion.
9 Many of these charities have not historically been involved in health, and
there are institutional limits on how much of the endowment could be spent, but some
percentage of these endowments might be made available to respond to a catastrophic
pandemic if enough charities responded to a global call to action.
Numbers in the Scenario
ReplyDeleteSeveral financial events and estimates are depicted in the Event 201 exercise. These
represent one possible scenario that could happen in a catastrophic pandemic.
Amount of Money Raised
In the scenario, there is a large and successful mobilization of funds. Donor countries are
convinced to contribute roughly 40% of their annual aid budgets to CAPS response, for $80
billion, and private charities spend down some of their endowments to contribute an
additional $20 billion, for a total of roughly $100 billion in additional financing.
Cost of Supporting Health Systems
About $6 billion was disbursed by donors in response to the 2014-2016 West Africa Ebola
epidemic.10 At the point in the scenario where the $400 billion estimate is made, it is
assumed that CAPS would cause case counts and expenses in low- and middle-income
countries about 2 orders of magnitude higher than the Ebola epidemic.
CAPS would, in many cases, cause emergency spending that would quickly consume all of
countries’ annual healthcare budgets. They would then need a bailout to continue normal
functioning as well as providing minimal pandemic response. Low- and middle-income
countries typically spend about 5% of GDP on health care, and in a crisis situation,
everything gets more expensive. The total GDP of low- and middle-income countries
(excluding China, India, and Russia) is about $14 trillion. If these countries require a bailout
of, on average, slightly more than half of their annual healthcare spending, this would be
$400 billion.
References
1. World Bank. Pandemic Emergency Financing Facility. Updated May 7, 2019.
https://www.worldbank.org/en/topic/pandemics/brief/pandemic-emergency-financingfacility. Accessed October 14, 2019.
2. International Bank for Reconstruction and Development. Prospectus supplement dated June 28,
ReplyDelete2017. http://pubdocs.worldbank.org/en/882831509568634367/PEF-Final-ProspectusPEF.pdf. Accessed October 14, 2019.
3. World Bank. International Development Association. Crisis Response Window. 2019.
http://ida.worldbank.org/financing/crisis-response-window. Accessed October 14, 2019.
4. International Development Association. IDA18 Mid-Term Review—Crisis Response Window:
Review of Implementation.
http://documents.worldbank.org/curated/en/537601542812085820/pdf/ida18-mtr-crwstocktake-10252018-636762749768484873.pdf. Accessed October 14, 2019.
5. International Monetary Fund. Where the IMF gets its money. March 8, 2019.
https://www.imf.org/en/About/Factsheets/Where-the-IMF-Gets-Its-Money. Accessed October
14, 2019.
6. International Monetary Fund. IMF lending. February 25, 2019.
https://www.imf.org/en/About/Factsheets/IMF-Lending. Accessed October 14, 2019.
7. Wikipedia. List of development aid country donors. Updated August 12, 2019.
https://en.wikipedia.org/wiki/List_of_development_aid_country_donors. Accessed October 14,
2019.
8. Council on Foundations. The State of Global Giving by U.S. Foundations: 2011-2015. 2018.
https://www.issuelab.org/resources/31306/31306.pdf. Accessed October 14, 2019.
9. Wikipedia. List of wealthiest charitable foundations. Updated September 27, 2019.
https://en.wikipedia.org/wiki/List_of_wealthiest_charitable_foundations. Accessed October 14,
2019.
10. Huber C, Finelli L, Stevens W. The economic and social burden of the 2014 Ebola outbreak in
West Africa. J Infect Dis 2018; 218(suppl 5):S698-S704.
MEDICAL COUNTERMEASURES
ReplyDeleteStatus of Supplies and Distribution/Allocation Systems
Prepared by Divya Hosangadi
CAPS Antiviral
• In addition to vaccines, monovalent antibody therapies and antivirals have been
investigated for treating coronavirus infections (Table 1).
• In this scenario, extranavir is a FICTIONAL antiviral drug.
o Extranavir is currently used to treat HIV but has been shown to be an
effective treatment for CAPS.
o Extranavir may be an effective prophylactic if given throughout a period of
possible exposure to the virus.
o When used as a therapeutic, extranavir may reduce the severity of disease
and length of viral shedding in infected individuals.
o Extranavir is a generic drug that is manufactured in 5 countries, including
the US and China.
o About 1 million people per day take extranavir to treat HIV.
o If all extranavir users were switched to a different HIV treatment, current
supplies of the antiviral could treat up to 26 million CAPS patients.
o It may be possible to double production of extranavir by expanding existing
manufacturing capacity and by licensing the drug to additional
manufacturers. This expansion could allow for 52 million treatment
courses per year but would likely require a year to reach that capacity.
o If extranavir were used broadly as a prophylactic rather than a treatment, a
much greater supply of the drug would be needed.
Current Vaccines in Development
• There are no vaccines currently licensed and available for use against any
coronavirus. Coronavirus vaccines for SARS and MERS have been technically
challenging to develop and have not made it out of clinical trials.1-3
While scientists are researching a vaccine against the FICTIONAL CAPS virus, there
ReplyDeleteis currently no product in development.
• Development of a vaccine against the CAPS virus will likely take years to achieve.
The vaccine development process can take more than a decade.
4 In pandemic
situations, the timeline for vaccine development could possibly be shortened, but
developing and manufacturing a vaccine against CAPS in time to control this
pandemic is unlikely.
• Vaccines against SARS or MERS coronaviruses would likely not be protective
against CAPS, because coronaviruses are prone to genetic reassortment; therefore,
a vaccine against one coronavirus is not cross protective against another
coronavirus.1,5
• Some experiments have raised the possibility that immunity incurred from certain
coronavirus vaccines can be short lived6,7 and that enhanced disease may result
from certain coronavirus vaccines.6-8 This has prompted some concern that
vaccines targeting coronaviruses (eg, MERS, SARS) could lead to adverse events.
Current Medical Countermeasure Distribution and Allocation Systems
• Current supply chain mechanisms exist to distribute vaccines and other medical
countermeasures (MCMs) on a routine basis. However, a centralized and scalable
MCM distribution system for use during pandemics does not exist.
• Multiple systems and stakeholders can facilitate MCM distribution in smaller scale
public health emergencies and could be either scaled up or provide lessons for a
pandemic context. These include:
o The International Coordinating Group on Vaccine Provision (ICG),
20 a
coordinating group of key global health stakeholders, including the World
Health Organization (WHO), UNICEF, Médecins Sans Frontières (MSF), and
the International Federation of the Red Cross. The goal of this group is to
handle the allocation of particular vaccine stockpiles for specific diseases
(cholera, meningococcal meningitis, yellow fever).
o WHO also has stockpiles for other diseases, including smallpox and
pandemic influenza.21
o WHO Contingency Fund for Emergencies22
§ Can release initial funds up to $500K in 24 hours
§ Serves as the potential source of funds for initial emergency response
if properly funded
o The US President’s Emergency Plan for AIDS Relief (PEPFAR) is a US-funded
program to control the HIV/AIDS epidemic and is the largest effort by any
one nation to control a disease.
23 PEPFAR funds programs aimed at
expanding access to HIV treatments and prevention services in low-income
settings.23,24
o Gavi, the Vaccine Alliance, procures vaccines for low-income countries for
selected routine and emergency immunization. For example, the
organization procured $300 million for Ebola vaccines during the 2014-2016
Ebola outbreak.25
• Challenges with ensuring equitable access to and distribution of MCMs have been
encountered in the past. Countries have withheld sharing samples in an effort to
secure access to MCMs.26,27
10. National Institutes of Health. Phase I Study of a Vaccine for Severe Acute Respiratory Syndrome
ReplyDelete(SARS). ClinicalTrials.gov. Updated July 2, 2017.
https://clinicaltrials.gov/ct2/show/NCT00099463. Accessed October 8, 2019.
11. National Institutes of Health. Study of Alferon® LDO (Low Dose Oral) in Normal Volunteers.
ClinicalTrials.gov. Updated April 17, 2013. https://clinicaltrials.gov/ct2/show/NCT00215826.
Accessed October 8, 2019.
12. National Institutes of Health. SARS Coronavirus Vaccine (SARS-CoV). ClinicalTrials.gov. Updated
December 3, 2012. https://clinicaltrials.gov/ct2/show/NCT00533741. Accessed October 8,
2019.
13. National Institutes of Health. Phase I Dose Escalation SARS-CoV Recombinant S Protein, With
and Without Adjuvant, Vaccine Study. ClinicalTrials.gov. Updated February 15, 2013.
https://clinicaltrials.gov/ct2/show/NCT01376765. Accessed October 8, 2019.
14. National Institutes of Health. MERS-CoV Infection Treated with a Combination of Lopinavir
/Ritonavir and Interferon Beta-1b. ClinicalTrials.gov. Updated March 7, 2019.
https://clinicaltrials.gov/ct2/show/NCT02845843. Accessed October 8, 2019.
15. National Institutes of Health. Safety, Tolerability, and Pharmacokinetics of SAB-301 in Healthy
Adults. ClinicalTrials.gov. Updated June 12, 2018.
https://clinicaltrials.gov/ct2/show/NCT02788188. Accessed October 8, 2019.
16. National Institutes of Health. Safety, Tolerability and Immunogenicity of Vaccine Candidate
MVA-MERS-S. ClinicalTrials.gov. Updated October 2, 2019.
https://clinicaltrials.gov/ct2/show/NCT03615911. Accessed October 8, 2019.
17. National Institutes of Health. A Safety, Tolerability, Pharmacokinetics and Immunogenicity Trial
of Co-administered MERS-CoV Antibodies REGN3048 and REGN3051. ClinicalTrials.gov.
Updated February 1, 2019. https://clinicaltrials.gov/ct2/show/NCT03301090. Accessed
October 8, 2019.
18. National Institutes of Health. A Multi-centre, Double-blinded, Randomized, Placebo-controlled
Trial on the Efficacy and Safety of Lopinavir/Ritonavir Plus Ribavirin in the Treatment of Severe
Acute Respiratory Syndrome. ClinicalTrials.gov. Updated August 22, 2013.
https://clinicaltrials.gov/ct2/show/NCT00578825. Accessed October 8, 2019.
19. National Institutes of Health. Anti-MERS-CoV Convalescent Plasma Therapy. ClinicalTrials.gov.
Updated November 21, 2018. https://clinicaltrials.gov/ct2/show/NCT02190799. Accessed
October 8, 2019.
20. World Health Organization. International Coordinating Group (ICG) on Vaccine Provision. April
3, 2019. http://www.who.int/csr/disease/icg/en/. Accessed October 8, 2019.
21. Yen C, Hyde TB, Costa AJ, et al. The development of global vaccine stockpiles. Lancet Infect Dis
ReplyDelete2015;15(3):340-347.
22. World Health Organization. Enabling Quick Action to Save Lives: Contingency Fund for
Emergencies. 2018. http://origin.who.int/emergencies/funding/contributions/cfe-impactreport-web2018.pdf. Accessed October 14, 2019.
23. US Department of State. About Us – PEPFAR. https://www.state.gov/about-us-pepfar/.
Accessed October 9, 2019.
24. US Department of State. PEPFAR 2018 Progress Report: PEPFAR Strategy for Accelerating
HIV/AIDS Epidemic Control (2017-2020). https://www.state.gov/wpcontent/uploads/2019/08/2018-PEPFAR-Strategy-Progress-Report.pdf. Accessed October 14,
2019.
25. Gavi. Gavi commits to purchasing Ebola vaccine for affected countries. December 11, 2014.
https://www.gavi.org/library/news/press-releases/2014/gavi-commits-to-purchasing-ebolavaccine-for-affected-countries/. Accessed October 8, 2019.
26. Baumgaertner E. China has withheld samples of a dangerous flu virus. New York Times August
27, 2018. https://www.nytimes.com/2018/08/27/health/china-flu-virus-samples.html.
Accessed October 8, 2019.
27. CIDRAP. Roos R. Indonesia details reasons for withholding H5N1 viruses. CIDRAP July 15, 2008.
http://www.cidrap.umn.edu/news-perspective/2008/07/indonesia-details-reasonswithholding-h5n1-viruses. Accessed October 8, 2019.
28. Pronker ES, Weenen TC, Commandeur HR, Osterhaus AD, Claassen HJ. The gold industry
standard for risk and cost of drug and vaccine development revisited. Vaccine
2011;29(35):5846-5849. d
29. Adalja AA, Watson M, Cicero A, Inglesby T. Vaccine Platforms: State of the Field and Looming
Challenges. Johns Hopkins Center for Health Security. 2019.
http://www.centerforhealthsecurity.org/our-work/publications/vaccine-platforms-state-ofthe-field-and-looming-challenges. Accessed October 14, 2019
Total Deaths for now -
ReplyDelete5.034.060