Forum on Microbial Threats: 2017 Year in Review (2018)

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2017 YEAR IN REVIEW FORUM ON MICROBIAL THREATS The Forum on Microbial Threats was created in 1996 at the request of the U.S. Centers for Disease Control and Preven- tion and the National Institutes of Health to provide a structured opportunity for discussion and scrutiny of critical, and possibly contentious, scientific and policy issues related to research on and the prevention, detection, surveillance, and responses to emerging and reemerging infectious diseases in humans, plants, and animals, as well as the microbiome in health and disease. The Forum brings Peter Daszak, Chair Kent Kester, Vice Chair Mary Wilson, Vice Chair together leaders from government agencies, industry, academia, and non- MESSAGE FROM THE CHAIRS profit and philanthropic organizations to facilitate cross-sector dialogue and We are pleased and honored to assume the leadership of the Forum collaboration through public debate on Microbial Threats. We thank our previous leaders, David Relman, Jim Hughes, and Lonnie King for creating a tradition of excellence and open- and private consultation to stimulate ness to new ideas and for building an impressive legacy and body of original thinking about the most pressing work reflected in workshop proceedings that have influenced across issues across the spectrum of microbial many disciplines. threats. The Forum offers a unique opportunity to focus on topics that are Despite decades of progress, the need critically relevant now, and likely to grow in importance in the future. We for the Forum on Microbial Threats explore them by drawing upon the best content experts globally and by remains. Problems such as MERS, Ebola, spanning disciplinary divides. The Forum has a long history of breaking Chikungunya, Zika, yellow fever, and down intellectual barriers, identifying new interfaces, and creating novel synergies to tackle global threats to our health. At the same time, we antibiotic resistance demonstrate how strive to identify interventions and potential solutions that are innovative, the issue of emerging infections is global practicable, and impactful. and unrelenting. The drivers are ever more pervasive, and the consequenc- We hope to have the creativity, breadth of vision, and boldness to es—human, social, and economic— continue expanding the Forum’s impact, and look forward to working in this privileged environment that includes some of the foremost thinkers on loom larger than ever. emerging threats. We aim to maintain a global perspective, and one that The Forum convenes several times each integrates an understanding of plant, animal, human, and environmental year to identify and discuss key problems health — a One Health approach and a global health outlook. and strategies in the area of microbial The Forum draws on the strength of its remarkable members, who threats. To supplement the perspectives bring rich, diverse experiences, broad disciplinary knowledge, and the and expertise of its members, the Forum capacity to think broadly and deeply. While we have conducted some also holds public workshops to engage a remarkable work over the last two decades, we have an unfinished wide range of experts, members of the agenda, and face a rise in the frequency of emerging disease events, growing threats from antimicrobial resistance, and continued expansion public, and the policy community. All of the underlying drivers of pandemics. We do not expect to solve all workshops are summarized in high- problems created by these microbial threats to health, but we will strive to quality, scholarly workshop proceedings shine a bright light on the ecological, socioeconomic, and that are available for free download demographic factors that underpin them. We look forward to this from the National Academies Press. challenge and to the stimulating journey ahead. 1 

A FOCUS ON ONE HEALTH FORUM ACTIVITIES IN 2017 The One Health Work Group was launched on January 18, 2017, to JUNE 20-21: Combating Antimicrobial Resistance: A One Health engage a community of partici- Approach to a Global Threat pants who are interested in con- Watch Webcast // Download Proceedings tributing to a detailed ongoing exploration and information shar- Major drivers of antimicrobial resistance in humans have been ing related to One Health topics accelerated by inappropriate antimicrobial prescribing in health care and accelerating the implementa- practices; the inappropriate use of antimicrobials in livestock; and the tion of a One Health approach in promulgation of antibiotic resistance genes in the environment. To build on previous work, to explore developments since the last work- the field. It is comprised of 15 shop was convened, and to help parlay knowledge into immediate members, including forum mem- action, the Forum hosted a 2-day public workshop that explored issues bers and external stakeholders of antimicrobial resistance through the lens of One Health, which is a from multiple sectors and disci- collaborative approach of multiple disciplines—working locally, plines, and is led by forum nationally, and globally—for strengthening systems to counter member Jonna Mazet, as chair. infectious diseases and related issues that threaten human, animal, and environmental health, with an end point of improving global Seven work group discussions were health and achieving gains in development. held in the past year, including an in-person meeting that coincided with the Forum workshop on In less than 1 month since its public release, December 12. Discussions have the workshop proceedings for “Combating touched upon a range of One Antimicrobial Resistance: A One Health Health topics based on participant Approach to a Global Threat” has been interest: core competencies, work- downloaded in 106 countries and 47 U.S. force, economics, and zoonotic states, plus DC. disease prioritization for the United States. DECEMBER 12-13: Urbanization and Slums: New Transmission As this work group transitions into a Pathways of Infectious Diseases in the Built Environment One Health Action Collaborative in 2018, members will continue Watch Webcast // Proceedings to be released in June 2018 focusing on developing: The Forum, in collaboration with the National Academies Board on Life Sciences, hosted a 1.5-day public workshop examining new  A discussion paper examining transmission pathways of microbes in the urban built environment that One Health core competen- affect human health. This workshop featured discussions on the social, cies in academic programs in physical, environmental, and political drivers of infectious disease the United States. transmission in an increasingly urban and interconnected world; effective interventions and policies to achieve sustainable, health-  A discussion paper examining promoting urban built environments; and strategies to close the how One Health graduates are research gap and scale up successful practices. placed within the workforce and if this training addresses 44 external stakeholders convened in person and remotely the needs for both trainees across sectors, including urban planning, mechanical and employers. engineering, slum health, and infectious diseases to contribute to dynamic panel discussions and breakouts on Stay tuned for their release! priorities in research and potential next steps to advance the field. 2 

UPCOMING FORUM ACTIVITIES IN 2018 “ Save the Dates for Our Workshops! Better appreciation of the role of the environment...and the need to engage June 12-13: Understanding the Economics of with the environmental health and science Microbial Threats communities more effectively. Breakout Registration to open in April groups were an important contribution to Join the Forum for a ” thinking about short-term priorities. ” 1.5-day public work- shop that will examine - Participant feedback from June 2017 the interaction of Combating Antimicrobial Resistance: A One Health economic activity and Approach to a Global Threat workshop m icrobial threats, including infectious disease outbreaks and antimicrobial resist- ance. The workshop will focus on the need for key metrics of risk and analytical tools to provide a comprehen- sive understanding of the economic risk that microbial threats pose. We will also explore approaches to incorporating estimates of infectious disease risk January 30: A One Health Approach for Tackling to overall macroeconomic assessments of Antimicrobial Resistance: Moving from Knowledge economic growth in countries to incentivize to Action — A Side Event for the Prince actions that minimize these threats. Mahidol Award Conference (PMAC) 2018 in Bangkok, Thailand November 27-28: Readiness for Microbial Building on the June 20-21 Forum workshop Threats 2030 Combating Antimicrobial Resistance: A One Stay tuned for developments on the workshop Health Approach to a Global Threat, as well as the statement of task. PMAC 2016 and 2017 side meetings on antimicrobial resistance, this closed meeting at PMAC 2018 will gather international experts across the One Health domains to further articulate a near term, action-oriented agenda to address AMR across multisectoral cross-cutting topics: 1) Surveillance under a One Health Approach; 2) Rational Use of Antimicrobials; and 3) Global Policy and Coordination. This event is being organized in collaboration with the U.S. Agency for International Development and Wellcome Trust. 3 

FORUM SPONSORS (as of December 2017)  U.S. Agency for International Development  Uniformed Services University of the Health Sciences  U.S. Army Medical Research and Materiel  American Society for Microbiology Command  Infectious Diseases Society of America  U.S. Centers for Disease Control and Prevention  Johnson & Johnson  U.S. Department of Homeland Security  Merck & Co., Inc.  U.S. Department of Justice-Federal Bureau of Investigation  Sanofi Pasteur  U.S. Department of Veterans Affairs  Skoll Global Threats Fund  U.S. Food and Drug Administration  U.S. National Institutes of Health FORUM STAFF FORUM MEMBERS (as of December 2017) Cecilia Mundaca Shah, M.D., Dr.P.H. David A. Relman, M.D. (Chair)* Marlo Libel, M.D., M.P.H. Forum Director Stanford University Skoll Global Threats Fund 202-334-26622 Carmen T. Maher, M.A., B.S.N., R.N. James M. Hughes, M.D. (Vice Chair)* CShah@nas.edu Emory University U.S. Food and Drug Administration Lonnie J. King, D.V.M., M.P.A. (Vice Chair)* Jonna Mazet, D.V.M., M.P.V.M., Ph.D. V. Ayano Ogawa, S.M. The Ohio State University University of California, Davis Program Officer Kevin Anderson, Ph.D. Sally A. Miller, Ph.D. 202-334-1349 U.S. Department of Homeland Security The Ohio State University VOgawa@nas.edu Timothy Burgess, M.D., M.P.H. Suerie Moon, Ph.D., M.P.A. Uniformed Services University of Health The Graduate Institute, Geneva T. Anh Tran Sciences David Nabarro, B.M.B.Ch., MFPHM, FRCP Dennis Carroll, Ph.D. 4SD, formerly the United Nations Secretariat Senior Program Assistant U.S. Agency for International Development George H. Poste, D.V.M., Ph.D.* 202-334-3984 Arizona State University TTran@nas.edu Peter Daszak, Ph.D. EcoHealth Alliance Kumanan Rasanathan, M.B.Ch.B., M.P.H UNICEF Julie Pavlin, M.D., Ph.D., M.P.H. Jeffrey S. Duchin, M.D.* Gary A. Roselle, M.D. Director, Board on Global Health Public Health—Seattle and King County U.S. Department of Veterans Affairs 202-334-2171 Emily Erbelding, M.D., M.P.H. Peter A. Sands, M.P.A. JPavlin@nas.edu U.S. National Institutes of Health Harvard University Marcos Espinal, M.D., Dr.P.H., M.P.H. Thomas W. Scott, Ph.D. Pan American Health Organization University of California, Davis STAY CONNECTED Jennifer Gardy, Ph.D. University of British Columbia, Canada Janet Shoemaker American Society for Microbiology Our web page: Jesse L. Goodman, M.D., M.P.H. Jay P. Siegel, M.D. www.nationalacademies.org/ Georgetown University Retired At-Large Member MicrobialThreats Eva Harris, Ph.D. Jami Taylor University of California, Berkeley Johnson & Johnson Follow @NASEM_Health on Twitter Caroline S. Harwood, Ph.D. University of Washington Paige E. Waterman, M.D. and use #MicrobialThreats at our Elizabeth D. Hermsen, Pharm.D., M.B.A. Walter Reed Army Institute of Research meetings. Merck & Co., Inc. Mary E. Wilson, M.D. Kent E. Kester, M.D. University of California, San Francisco Sanofi Pasteur Edward H. You, M.S. Rima F. Khabbaz, M.D. U.S. Federal Bureau of Investigation U.S. Centers for Disease Control & Prevention —————————————— *Members rotating off in 2018 www.national-academies.org 4