Four coronavirus prevention steps we can all take

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Fox News Opinion. With the first coronavirus fatality recorded here in the United States, there is a heightened alarm around what may lie ahead for all of us. In truth, there is no telling what damage this force of nature may leave in its wake. But that is not to say that there is nothing we can do to weaken its impact. Protecting ourselves from the virus is a collective responsibility that requires action from each of us to varying degrees. First, we must consider how each of us responds personally to the threat of an outbreak. There are basic handwashing and hygiene techniques that can limit our chances of infection and help us prevent the spread of the disease if we are unknowingly infected. We can avoid large crowds, wash our hands regularly, cover our mouths when we cough or sneeze and start preparing our homes for the possibility that we'll fall ill and need to stay home while sick. Second, we must think of how we will respond as a community and what we do collectively to ready ourselves. If you work in health, make sure frontline healthcare workers have a steady supply of protective equipment and that protocols are in place to meet a surge in demand. Bolster telehealth capabilities now so that in the event of an outbreak we can counsel patients remotely and direct them to the right level of care for their medical needs. If you work outside of the healthcare community, prepare your workplace environment to protect yourself and all employees. Ask leaders at your schools, places of worship and other public gathering places how they will respond in the event that the virus spreads. The third effort we must focus on may lie beyond most of our individual domains but is equally important for us to understand and support - the scientific effort towards a medical solution. Efforts to develop a combination of drugs that can treat those who are newly infected and prevent them from passing the infection on to others should be paramount. The onus for this work does not lie solely with scientists and researchers, but also with the pharmaceutical industry and government who must provide researchers with the necessary resources. One of the best steps we can take now to spur action on both sides is to list the coronavirus as an emerging biothreat under the Biomedical Advanced Research and Development Authority (BARDA) and its Project BioShield. Such a move would create a market for an anti-coronavirus drug that doesn't currently exist. Finally, and perhaps most importantly, we must consider how we talk about the potential threat we face. We do not yet know the trajectory of this outbreak but even the most sanguine among us will admit to at least a hint of fear of what may come. Clear, concise and credible public health communications are imperative in this time of crisis. If we can't trust what our leaders are telling us to do or - worse yet - if they leave us confused about the possible risk, we leave ourselves fully exposed to the forces of nature and all the worst that this virus can bring.

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Mapping A Better Life For Older Adults Of New York

This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. Two weeks ago, The New York Academy of Medicine relaunched its data visualization tool IMAGE: NYC, otherwise known as the Interactive Map of Aging. Created in partnership with the Center for Urban Research at CUNY, the open source, data driven map helps users navigate local resources and services-specifically, those of value to the million plus older adults living in New York City-in the context of broader demographic patterns and trends, which include everything from household income and employment status to place of birth and specific disabilities. Rare is it that a map featuring around 150 demographic overlays has zoom functionality strong enough to swoop down to the street level. That's what makes IMAGE: NYC so unique: the ability to survey the cityscape from up above and down below. Users can locate community health centers, public transportation options, and other supports available to older residents in a particular neighborhood, while at the same time learning about the structural challenges that complicate matters of access. Recreational assets like public swimming pools and botanical gardens are also mappable. As Lindsay Goldman, project lead and director of Healthy Aging, put it, "There has to be more to life than going to the doctor and getting a visit from a social worker. It just has to be better than that, you know?" By placing sectors that normally operate in isolation on the same plane, IMAGE: NYC gives the policymakers, funders, providers, and other stakeholders who make up its target audience a "sense of network," in Goldman's words. For older adults and the people caring, advocating, and providing for them, a sense of network-that certain familiarity, collectively formed, with where and how people and resources interconnect-is a vital asset. "When organizations, institutions, and people are aware enough of each other to develop these networks," Goldman said, "they can bridge their services to the community they are situated in." This holds especially true in urban environments, where the supports available to older adults are so numerous and the barriers thwarting them so entrenched. No network, sadly, is complete without its weak links and gaps-and no event in New York City's recent history, at least in the context of aging infrastructure, exposed those more than Hurricane Sandy. Whether it was sustained interruptions to caregiving and medication regimens, or conditions of isolation or perceived abandonment due to lines of communication gone dark, many of the challenges faced by residents 65 and older in the storm's wake were variations on everyday difficulties. Inspiration for the IMAGE: NYC project originally came out of the Academy's yearlong study, again led by Goldman, of older adults impacted by the 2012 superstorm. The final 2014 report found that, when emergency aid failed, it was ultimately neighbors, faith circles, building service workers, and community based organizations that stepped up and cared for older adults. Interventions that take advantage of tools like IMAGE: NYC, both in the context of disaster response and beyond, stand a better chance of harnessing these existing social networks as conduits for resources and information. Plans are in the works to optimize the map for usage by older adults themselves and eventually crowdsource data on the quality of various resources and services. Goldman hopes that qualitative data-of which the Academy has an impressive repository, gathered over years from different initiatives on aging-will become a more integral component of the map in future iterations. Judith Salerno, President of The New York Academy of Medicine, has a favorite demographic: grandparent caretakers, or households where grandparents are primary caregivers. Applying the grandparent caretaker and lack of English proficiency layers to the map, for instance, shows us a large concentration of households in the South Bronx exhibit both. "What happens when those kids need to go to the pediatrician?" Salerno asked. That is just the sort of connection-between social conditions and health and wellness-that the IMAGE: NYC map can illuminate.

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ACCESS Health China Explores Digital Solutions to Coronavirus Control and Infectious Disease Management

As the world struggles to manage the healthcare needs created in the wake of the latest coronavirus outbreak, our ACCESS Health China team has embarked on a new effort to identify digital health solutions that are playing critical roles in disease control. In China, where there have been more than 75,000 confirmed cases and 2,500 confirmed deaths, many digital health providers have launched new services and products to mitigate the spread of COVID-19 and the devastation left in its wake. Systematic studies on the roles and benefits of digital solutions in pandemic surveillance and containment is currently very limited. To fill that gap, ACCESS Health China team is conducting a real time study on digital solutions to the outbreak. The research will improve understanding of what digital health technologies have already done in response to the spread of COVID-19 and identify opportunities for the creation of additional digital solutions in the near future. The evidence based research will also lead to a set of recommendations for health authorities and other key stakeholders for future outbreaks. The research team, which is funded entirely from ACCESS Health's own budget, designed an adaptive, integrated disease surveillance and response framework consisting of five core elements: Disease surveillance: monitoring and reporting Response time: diagnosed patient tracking, control and management of suspected patients, and key area control Epidemiological study: study of the virus and its mutations Disease management: diagnosis, treatment, and ongoing management Supportive activities: including fundraising, procurement, mental health support, communications The team built a live database of digital solutions in China based on the five core elements of the disease epidemic response framework then selected more than thirty influential solutions for further study. Case studies were developed for each of these solutions, including the intervention methods to meet unmet needs, implementation of the technologies, the partners involved, and expected impacts. The research team is currently analyzing the remaining opportunities, key barriers, and policy gaps for each of the five core elements. Both the database and the case study collection will be updated continuously as the outbreak evolves. ACCESS Health China will eventually combine all case studies into a final report on the roles and potential benefits of digital solutions in pandemic surveillance and containment. We expect the policy recommendations generated from the research to guide policy on how digital technologies can be incorporated into pandemic responses, not only in China but also in other regions of the world. ACCESS Health China is also working on building the bridge between health authority and major industry players to promote new partnerships and innovations to overcome the outbreak together.

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US hospitals are unprepared for the spread of coronavirus. Here’s what they need to do.

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in the Los Angeles Times.  When the new coronavirus COVID-19 first broke out, China's health care system was unprepared. Hospital waiting rooms were so packed with prospective patients that hundreds more had no choice but to line up outside. Many waited several hours, only to be turned away and urged to self-quarantine. More troubling, experts say, is the fact that the chaos of this initial surge likely did more to spread the disease than stop it. The same fate awaits us here if the new virus becomes a global pandemic. Hospitals in the United States are already so overburdened, and their staffs so overworked, that one bad flu season is enough to push them over capacity. Just two years ago, during a particularly bad season in California, patients seeking treatment for the flu instead found themselves in "war zones."  Hospitals turned away ambulances, imported nurses from elsewhere and erected parking lot tents when they ran out of beds. Surgeries had to be cancelled and hospitals ran out of supplies. If the new coronavirus gains momentum here, infecting thousands, the outlook would be even grimmer. To be sure, we are better prepared than we were for the last coronavirus outbreak in 2009. Our hospitals now have pandemic plans to ensure that enough equipment, protective gear, and administrative controls are available to deal with a surge of new patients. But, on their own, these measures are not enough. First, we must do more to make sure that if an outbreak occurs, we can keep and treat people where they are safest — in their homes. That will require leveraging or boosting the telehealth capabilities of local clinics to enable remote diagnosis of emergent coronavirus cases. Such virtual consultations would divert pressure away from hospitals and limit the transmission of infections in crowded waiting rooms. Second, we must ensure that any added costs of protection and prevention are covered for patients.  Currently, payment by insurance companies for virtual urgent care is not federally mandated, and many plans don't cover it. Without a guarantee that their costs will be covered, patients may still head to hospitals to avoid the fees. Finally, we must prepare our hospitals and our health systems now for future crises even greater than the one we may face with COVID-19. This latest coronavirus is, by all appearances so far, more benign than some previous ones. Though it is highly transmissible, it has a low mortality rate, with the vast majority of those infected surviving whether they are treated at home or in a hospital. But there will come a time when a coronavirus outbreak or other biothreat emerges that is more lethal and widespread than anything previously seen. Our hospital-centric health system isn't equipped to handle such a crisis. We must forge a new path toward a health system of distributed care, where patients receive care where they need it most-not just in hospitals, but in the home and community. The United States is home to some of the world's best health providers and technological innovations. But we still hold to an antiquated notion that advanced healthcare is best delivered in hospitals. Countries like Singapore have shown that distributed care can be achieved on a national scale, and if they can do it, so can we.

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Scientists warned about coronavirus for years but got nowhere. Here’s how to fix that.

This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in the Washington Post.  Nature is teaching us a heavy lesson with this latest coronavirus outbreak. It warned us first with SARS and then with MERS, but we didn't heed the warnings. If we willfully ignore nature this third time, our global community risks paying an unimaginable price. In 2003, when SARS was first reported, the origins of the virus were a mystery. Scientists suspected it may have come from bats, but it wasn't until 2012, when the second major coronavirus outbreak was spreading across borders, that researchers confirmed its provenance. At the time of their discovery, they warned us of the outbreak potential of coronaviruses, urging the global community "to learn from our past to help us prepare." But we didn't pay attention. In the wake of the previous outbreaks, we scrambled to find a vaccine to prevent SARS and MERS specifically. But the coronavirus, much like the flu, is constantly evolving. In the same way that a flu vaccine doesn't work across multiple strains over multiple years, a vaccine for one coronavirus outbreak is unlikely to help us stop a new one. What was needed then and what is needed now is not just a new vaccine, but a drug - or more likely a combination of drugs - that can act against the family of coronaviruses. Since the SARS and MERS outbreaks, scientists have decried the lack of interest and funding for the study of coronaviruses as whole. While financing was available in the midst of the outbreaks, it petered out after each outbreak ended. Funding from the National Institute of Allergy and Infectious Diseases, for example, leveled off at around $27 million a year - peanuts in the world of drug development. The biopharmaceutical industry could have stepped in, but, so far, it has been loath to act. The intermittent nature of the outbreaks and the relatively small market for an anti-coronavirus drug means pharmaceutical companies have little incentive to pursue a solution. With scientists and researchers shackled by a lack of funds, and biopharmaceutical companies unwilling to step in without potential for profit, the government is the only one with the agency to act. There are concrete actions our government can take today to drive progress against the current coronavirus epidemic and to prevent future epidemics from occurring - a near certainty now according to scientists and researchers. The first step toward a solution is to list the coronavirus under the Biomedical Advanced Research and Development Authority (BARDA) and its Project BioShield. BARDA presides over the discovery, development and stockpiling of medical countermeasures to protect Americans against health security threats. This includes not just biological agents of warfare, but new and emerging infectious diseases - such as the coronavirus. BARDA bypasses the laws of supply and demand by allowing the federal government to pour hundreds of millions of dollars into procuring and advancing promising products. Listing the coronavirus as an emerging biothreat will create a market for an anti-coronavirus drug that doesn't currently exist. In the wake of the 2001 anthrax attacks, I worked through Project BioShield to develop ABthrax, a drug to treat and prevent anthrax infections. I can say with confidence that the U.S. government is fully capable of acting swiftly in the face of a public-health crisis. But it must choose to act now. To date, we have been lucky - insofar as one can use that term when lives are on the line - as none of the coronaviruses that have jumped to humans have been both highly transmissible and highly lethal. There will come a time though when a coronavirus outbreak will spread quickly and kill abundantly. When that happens, we will not be talking about deaths in the hundreds or thousands, but in numbers far greater. It is our collective responsibility to ensure that our government leverages the rapid response capabilities at its disposal to protect the health of our nation, now and for generations to come.

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ACCESS Health Southeast Asia Explores Fintech for Health in Bangladesh

Adrienne Mendenhall, Director of Business Development in Singapore and Tript Bhatia, Director, Startup Alliance visited Dhaka from January 19-22 to start Fintech for Health work in Bangladesh. Over three days the group attended more than a dozen events. The trip started with meetings with healthcare nongovernmental organizations, including the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), CARE, Marie Stopes International, BRAC, and Shakti Foundation. The team also met with two digital health startups to round out discussions on priority health financing needs for lower income populations in Bangladesh. Many of the discussions focused on the difficulty that women and their families have in saving for maternity care and the accompanying costs, including transportation. Nongovernmental organizations in Bangladesh have long focused on improving maternal and neonatal mortality through health messaging, including encouraging women to deliver in hospitals or at the very least with a skilled birth attendant. While the percentage of women delivering in healthcare facilities risen, half of births still take place at home. The reasons for this are multifold, including tradition, but also because of the costs involved in traveling to and delivering at a healthcare facility. Tript participated in a workshop held by Women's World Banking and funded by MetLife Foundation on financial inclusion for women garment factory workers. The government of Bangladesh mandated wage digitization in Bangladesh 5 years ago. 90% of garment workers will be brought under the digital wage system by 2021 as part of the government's push to build a cashless society. Banks such as Dutch Bangla Bank are taking advantage and are looking to increase uptake and use of their mobile financial service, Rocket by these factory workers. During this workshop, Women's World Banking shared their learnings from the pilot project that they launched with the bank with a readymade garment factory located on the outskirts of Dhaka. Specifically, they talked about the barriers to mobile account usage and how to address them. The group also met with three fintech companies: Bkash, the first to market and furthest reaching digital finance company in Bangladesh; Nagad, a public private partnership led by the Bangladesh post office; and Pathao, a ride sharing platform backed by Go-Jek. It was impressive to see the investments and traction that digital finance companies have gained in a short few years. The healthcare organizations we met said that almost everyone, no matter how poor or where someone lives, uses mobile money. The sector has gained a far reach that makes it a desirable partner for most merchants, from nonprofit organizations to SMEs and multinational corporations. Most healthcare organizations we met with are considering digital health financing models, including savings, lending, and insurance. There is significant mistrust of insurance in Bangladesh, with only 3-4% of the population holding insurance policies. For this reason, and combined with the messaging of maternity programs in Bangladesh, mobile health savings accounts are a likely starting point. The Singapore team will be returning next month to lead a roundtable discussion between healthcare organizations and one of the digital finance companies, and probably multiple times after that when activities ramp up.

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Why Are We So Fearful of the New Coronavirus?

This article was originally published on Psychology Today. In the thick of a disease outbreak, the line between panic and preparedness can feel perilously thin. For individuals living with comorbidities like chronic lung and immunodeficiency diseases, the new coronavirus is deadly. To protect them, certain precautions are, indeed, necessary, including the lockdowns enforced by the Chinese government and the temporary travel restrictions placed in the United States and elsewhere. For those who don't fall into that category, there is little reason to fear-and a lot of evidence to suggest that even if infection occurs, chances of recovery are high. So far, the mortality rate outside Wuhan, the epicenter of the new coronavirus, has remained below 1 percent. But the anxiety and panic induced by the disease seem as contagious as the disease itself, depleting the surgical mask supply of pharmacies worldwide. Plenty of health challenges lurk at our doorstep that do more damage and take more lives than the coronavirus. Take seasonal influenza or the flu. So far, there have been no less than 19 million cases of flu-related illnesses recorded this flu season, as well as 10,000 deaths. The new coronavirus, on the other hand, has sickened upwards of 64,000 and killed almost 1,400. The raw numbers cast the flu as a mightier foe-and yet the coronavirus, if its continuing domination of headlines is any indication, has it overshadowed by a wide margin. Why does the 2019-nCoV outbreak rile our fears so? The discrepancy has to do with how humans perceive risks. Novel threats provoke anxiety in a way that everyday threats do not, triggering a fear response that begins with the part of the brain known as the amygdala and travels via activation of "fight or flight" motor functions throughout the body. While this evolutionarily honed instinct for the unfamiliar and foreboding can sharpen the senses-a sort of physiological priming for confrontation with a predator-it can also confuse the mind. Many of us, for example, fear plane crashes more than car crashes, even though death by automobile is far more likely. Reminding ourselves of this fact, however, does little to undo the knot that forms deep in the stomach as the plane prepares for takeoff. If we can't trust our gut reactions to guide our response to the 2019-nCoV outbreak, then what can we trust? One option is to rely on de facto voices of authority: in this case, national governments. But in today's world, this is easier said than done. In China, suspicion of misinformation, intentional rumormongering, and questionable leadership decisions are crippling the lines of communication that run between the Chinese people and their ruling party. The same could be said of the relationship between the President and the people of the United States, where "alternative facts" have become a recurring theme in political discourse. There is one thing the United States government could do not just to halt further transmission of the new coronavirus, but alleviate the fears surrounding it. Leveraging existing funding mechanisms, like Project BioShield, to develop and stockpile a broad-spectrum, anti-coronavirus drug would both curb the current coronavirus outbreak and prepare populations for outbreaks to come. Unfortunately, until federal commitments of this caliber are made, it will be up to individuals and their communities to find ways to avoid panic in the face of certain doubt. Some of the more concrete, universally applicable strategies for managing outbreak-related fear and anxiety are safety and prevention-oriented, such as washing your hands regularly, handling food with care, and practicing good hygiene in general. Other methods might involve education and mindful media consumption-for example, seeking out updates from credible health institutions, like the World Health Organization and the Centers for Disease Control and Prevention, rather than media outlets more likely to circulate incomplete or false information. Last but not least, we should keep in mind that even if the coronavirus outbreak demands some degree of social distancing or isolation, staying connected with friends, family, and loved ones-whether it's through Skype, social media, or a simple phone call-is one of the best ways to cope. Instead of allowing fear to drive us further apart, we can choose instead to reach out, band together, and hold out hope that this novel threat, like so many others before, will be overcome.

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Prince Mahidol Side Meeting on Digital Technology to Achieve Universal Healthcare

ACCESS Health recently co-hosted a side meeting with Health Futures partner FHI360 on the use of digital technology in achieving universal healthcare. The side meeting was held at Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, a gathering that attracts hundreds of public health professionals from around the world to discuss key policy-related health issues. Our side meeting focused on the challenges that governments face in adopting digital technology for health and examples of on-the-ground digital health use cases. The side meeting began with a brief overview of ACCESS Health’s publication on the role of digital technology in achieving universal health coverage in ASEAN. Following this, a panel including experts in digital technology and infrastructure in Asia answered questions on topics around interoperability, building a national digital infrastructure, necessary human capital needed to build digital health ecosystems, supporting governments in establishing foundations for digital technology towards universal health coverage, and the importance of connecting doctors, payers, and patients to create this digital health framework. Panelist Dr. Krishna Reddy, Country Director at ACCESS Health India, opened the panel discussion by giving an overview of the India's path toward the National Digital Health Blueprint and the stacks built upon that strategy. The newly created program ACCESS Health Digital Health focuses on harmonizing digital health ecosystems using evidence-based approaches to bridge gaps between healthcare providers, payers, and the government. Dr. Boonchai Kijsanayotin, Chair of the Asia ehealth Information Network (AeHIN), discussed specifically about the importance of human interoperability – in addition to technical interoperability – in creating successful digital health ecosystems in ASEAN. He noted that many of these challenges have been persistent for decades. Paul Rueckert, Chief Technical Advisor at GIZ, discussed the current fragmentation of many digital health ecosystems and how some aide groups are contributing to this problem by funding multiple digital technology programs that are running in parallel to each other, instead of cooperatively. He also voiced a vision to create not just interoperable health information systems but rather interoperable government systems across sectors. Sarah Yee, Industry Consultant for Digital Transformation at Cisco, spoke about the great importance of private-public partnerships in creating national digital health infrastructures in ASEAN. Without these partnerships, we will fail to collect the right data needed – on a micro and macro scale – to make these ecosystems successful. Sarah also emphasized the need for infrastructure to underpin those government systems and why these issues standardization needs to be addressed preemptively. With more than 65 people in attendance, the audience was invited to participate in a Digital Health Challenge Tour, run by FHI360. The tour showcased three case studies on how they are using digital health to reach patients and clinicians directly, advancing access, patient education, and clinician engagement. The audience learned about the application of these platforms, discussed the challenges and successes of implementation, and brainstormed ideas to improve or expand the application of the platform.

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ACCESS Health Aging Books Featured on Here’s To Your Health Radio

ACCESS Health Chair and President William A. Haseltine was interviewed by Joshua Lane on the radio program, Here's To Your Health. The program explores ideas that can improve the health of people of all ages and their communities. In the interview, Dr. Haseltine discusses ways to improve active aging and steps that anyone can take to prevent the negative consequences traditionally associated with aging. Click this link to download the interview: https://accessh.org/wp-content/uploads/2020/02/Heres-To-Your-Health-with-Joshua-Lane.mov  

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Want to Prevent Another Coronavirus Epidemic?

This article was originally published on Scientific American. Once again we stand unprepared as the third epidemic of a new and deadly coronavirus races around the world. This need not have been the case. We should have learned from the SARS epidemic of 2003, which claimed nearly 800 lives, that coronaviruses can turn deadly. Until then, most health officials and scientists regarded coronaviruses simply as one of many causes of the common cold; some 30 percent of common colds start from coronaviruses. Then came the MERS epidemic in the Middle East in 2012, a coronavirus that killed 858 people. The irrefutable lesson from SARS and MERS: coronaviruses can spread quickly and be deadly. Why, then, is there no way to prevent or treat the disease in 2020? Science had the tools in the immediate aftermath of the previous two epidemics to develop the drugs to control future outbreaks. But health officials, scientists and governments, especially but not only in the United States and China, dropped the ball. There is no doubt that coronaviruses are wily opponents. Like all viruses of this type, the coronavirus mixes and matches components to create novel versions of itself. Bats are the natural hosts of the virus. There are more than 1,100 species of bats, each infected with one or more coronavirus variants. Think of the virus as a genetic safecracker, constantly evolving new combinations to extend its range and find new host species. Humans are on that menu. Each infection, deadly or not, is different from the last, which makes an effective vaccine or cure for the whole family of coronaviruses highly unlikely. Though we may not be able to develop a cure for those already ill, we can develop drugs that will prevent the disease from spreading. If we had done so after SARS and MERS, governments could have stockpiled the drugs years in advance of this latest outbreak and within one-day delivery to all locations where the virus has been detected or suspected. All patients, hospital workers and any other persons suspected of contact would have been treated to stop the epidemic in its tracks. I led the effort to develop an effective drug to prevent and treat anthrax following the 2001 attack and was a pioneer for the concept of using drugs to prevent transmission of HIV/AIDS from mother to child and between adults. Assessing the genome of this new virus, I see what we describe as a "target-rich" environment; that is, a virus that has many vulnerabilities to antiviral drugs, similar to those that have been exploited successfully for the treatment of HIV, hepatitis B and herpes viruses. The drugs, or combinations of drugs, that control those diseases bind and block the enzymes the viruses need to grow.  These enzymes are very similar to one another in all coronaviruses. This is a critical point. This common molecular pattern of all coronaviruses makes the challenge of identifying drugs to control coronaviruses less daunting. Scientists design drugs to inhibit the growth of specific virus enzymes. Once the genetic code of a virus has been sequenced, the targets for effective drugs appear. We now have witnessed three deadly coronavirus outbreaks in humans within 17 years. Once this new epidemic has faded into memory, will it be five or 10 years until the next one? We can and must develop, test and stockpile combinations of drugs that can protect against what is certain to be another coronavirus outbreak. In the wake of the 9/11 attacks, the U.S. government established the legal authority and executive process to do this. Known as BioShield, the program authorized funding to develop and stockpile effective means to prevent and treat "new and emerging biological threats." BioShield works. At Human Genome Sciences we developed the drug Anthrax to prevent and cure anthrax infections after the 2001 attacks. That drug is now stockpiled by the government. BioShield created the market for our work, committing many millions of dollars in purchase orders. The coronavirus is not now and has never been on BioShield's approved list of "new and emerging biological threats." It should have been added after SARS, then again after MERS. It should be added now. We have been forewarned.  The departments of Homeland Security, Health and Human Services, and Defense should convene a working group immediately to add coronaviruses to the BioShield agenda. The Centers for Disease Control and National Institutes of Health then can initiate contractual discussions with the biopharmaceutical industry. Biopharmaceutical companies have the expertise to create the drugs we need quickly to prevent a fourth outbreak. Collectively, scientists at these agencies and companies then can, and will, soon identify the drugs and produce the stockpiles that we need, that the world needs, to prevent a fourth deadly outbreak from a coronavirus, any coronavirus.

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