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://​​think­ingaboutchar­​​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 5050 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.