Medical Countermeasures

Who is in charge of carrying out our nation’s biodefense policy?  This question was raised repeatedly in Wednesday’s hearing of the Senate Labor-Health and Human Services subcommittee.  The hearing focused on bioterrorism, biosecurity, and medical countermeasures in contrast to last week’s senate hearing on terrorism during which the topic was barely mentioned.

The hearing was divided into two parts, with Health and Human Services Secretary Kathleen Sebelius testifying first about the department’s recent review of the entire medical countermeasure enterprise.

An anthrax outbreak in Bangladesh has infected more than 500 individuals since August 18^th.  The infections were acquired from eating or handling contaminated cattle.   In one instance, a man purchased a cow which became ill a few days later.  He brought the cow to a veterinarian where it was vaccinated against anthrax.  This would have been protective against future infections if the cow survived, but it did not treat the current infection.  The man slaughtered the cow when its condition deteriorated, and unknowingly fed the contaminated meat to over 40 families.  Contaminated meat is also being sold in the market, which has caused cattle and livestock sales to be around 1/10 of the expected levels.  Considering that around three quarters of the population rely at least partially on livestock for their livelihood, this outbreak is sure to take a heavy toll on the health of both the population and the economy.

Another RNAi based treatment for Ebola has been developed. Researchers at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) found that >60% of monkeys given a lethal dose of Zaire Ebola virus survived after treatment with AVI-6002, a targeted, positively charged, anti-sense phosphorodiamidate morpholino oligomers (PMO) developed by AVI BioPharma . Another targeted PMO, AVI-6003, was able to protect 100% of monkeys from a lethal dose of Lake Victoria Marburg virus. Both drugs were given daily for either 10 or 14 days. Both the Zaire Ebola virus and Lake Victoria Marburg virus are filoviruses that can cause deadly hemorrhagic fevers and are potential biological weapons agents.

As explained before, viral RNAi treatments consist of small pieces of RNA, siRNA, that bind and block specific viral RNA sequences.  

BARDA, the Biomedical Advanced Research and Development Authority of the Department of Health and Human Services (HHS), recently awarded four contracts for the research and development of innovative platform technologies in medical countermeasure development.

BARDA was established within HHS to manage the procurement and development of medical countermeasures, such as vaccines, drugs, and diagnostic tools, for biological, chemical, radiological, and nuclear agents, as well as for other public health emergencies, such as pandemic influenza and emerging infectious diseases. BARDA’s Strategic Science and Technology Division identifies and selectively funds research and technology that will improve the effectiveness and shorten the time and cost of medical countermeasure development. The innovative technologies awarded have all demonstrated success in late-stage clinical development for countermeasures against pandemic influenza and anthrax, two prevalent diseases of concern in public health and biosecurity.

Contracts were awarded to the following organizations to continue development: the Program for Appropriate Technology in Health (PATH), the Infectious Disease Research Institute (IDRI) in Seattle, VaxDesign Corp. in Orlando and Pfenex Inc. in San Diego. A collective total of $24.6 million is allotted for initial phases and up to $53.6 million over three years.

In late June, 30 hippopotamuses died of anthrax in Queen Elizabeth National Park, Uganda, a popular safari location. These hippopotamuses likely contracted Bacillus anthracis, the causative agent of anthrax, from spores that had been lying dormant in the lake shore soil for 6 years, originating from an anthrax outbreak in 2004 which killed approximately 300 hippos. Because B. anthracis spores are hardy and can survive for decades in the soil, proper disposal of infected carcasses is very important to control future outbreaks. The New Vision reports that the State Minister for the Animal Industry in Uganda, Major Rwamirama, recommended that the carcasses should be moved and the infected areas sprayed – the article did not mention with what. Major Rwamirama also mentioned that burying the carcasses was expensive, ~$440 per carcass, and unreliable, since burial does not kill the hardy spores.