Call notes with Johns Hopkins CHS

The below sets out call notes between Sanjay from SoGive and Anita Cicero, Deputy Director of Johns Hopkins Center for Health Security (CHS). We choose to publish those call notes which we believe are likely to be of most interest. This call occurred on Thurs 14th may 2020. This is also cross-posted to the SoGive blog: https://thinkingaboutcharity.blogspot.com/2020/05/call-with-johns-hopkins-chs.html

Currently CHS is heavily focused on COVID-19, with by far the majority of their effort going on this. However previously the centre has covered other areas, including other naturally occurring bio risks, man-made and deliberately employed bio risks (bio-weapons), and accidental bio risks.

The centre’s work is largely focused on independent research and development of recommendations to influence government policy.

Examples of recent work: Report on schools: this report looked at topics like coronavirus transmissibility, what are the gaps in knowledge, what is the research agenda, and what are things that should be considered in order to open schools. CHS is currently producing a large number of such reports, which are being turned around fairly quickly and are on the website. They are also frequently on calls with staffers from different congressional committees. They also perform a weekly call with mayors.

Their work, pre-COVID, is (very roughly) around ⁵⁰⁄₅₀ split between the US and international work. For example, they have a SE Asia multilateral dialogue to talk about biological risks. And also bilateral dialogue with India, and are in touch with the first Chinese biorisk NGO. If anything, they are perhaps moving more towards further international work. They have also done a lot of work with the WHO.

When asked about the most contentious policy proposal, the answer given was that CHS believes that the government should have a dedicated capability to develop medical countermeasures (including antivirals and vaccines) for previously unknown pathogens. While work has been funded and done on known agents that we’re worried about, e.g., anthrax, plague, etc. the world is currently not well-positioned for a pathogen we’ve never seen before, as the current coronavirus situation is illustrating. So this is a proposal to develop a “disease X” medical countermeasures program. This is a hard sell because government is already spending a lot on coronavirus.

More generally when asked about government appetite for taking action on bio risks, the sense is that lots of money is already being thrown at firefighting the most urgent coronavirus-related issues at a time when the government doesn’t have much money.

While the centre’s work is heavily focused on coronavirus at the moment, when asked about the future, they do expect to go back to their previous focus areas: large-scale naturally occurring bio risks, man-made and deliberately employed bio risks (bio-weapons), and high-consequence accidental bio risks.

CHS explicitly recommended against wearing DIY masks in early March (a position reversed by the end of the month). When asked about this, CHS observed that there’s still not great data and evidence on masks. And that there’s a risk that using it without proper training could lead people to touch their face more. However on balance CHS has updated their opinions on this, and further acknowledges that masks are helpful for source control.

CHS were not discouraging people from pressing ahead with travel plans as late as 6th March. When asked about this, they observed that it was a change in emphasis between a commonly-held earlier view, which was that travel bans don’t achieve much because they ultimately don’t change the number of people infected, they only delay the inevitable. The change in view was because they had previously underestimated the value of delaying infections.

When discussing the items referred to in the previous two paragraphs, CHS referred to the already established received opinion or “dogma”, and how recent experience has been upturning that dogma.

When asked about the current funding position, CHS indicated that their annual spend is somewhere in the range of c$8m, and that the coronavirus situation had not led to a general increase in funding, apart from funds from the EA community, which came to around $300k.

Extra funds could valuably be used on hiring some more junior staff or a somewhat more senior epidemiologist.