Wikipedia:Vaccine safety/Perennial sources/NAS bibliography

Bibliography from National Academy of Sciences, USA
The following is the bibliography related to vaccines from the National Academy of Sciences. If you have the skills, consider exporting them to Wikidata.


 * Institute of Medicine (2000). An Assessment of the Safety of the Anthrax Vaccine: A Letter Report. Washington, DC, The National Academies Press.
 * Institute of Medicine (2000). Calling the Shots: Immunization Finance Policies and Practices. Washington, DC, The National Academies Press.

Calling the Shots examines the basic strategies that finance the national immunization system in the current health care climate. It is a comprehensive volume, rich with data and highlighted examples, that explores: The evolution of the system in light of changing U.S. demographics, development of new vaccines, and other factors. The effectiveness of public health and health insurance strategies, with special emphasis on the performance of the program. The condition of the infrastructure for control and prevention of infectious disease, surveillance of vaccines rates and safety, and efforts to sustain high coverage. Calling the Shots will be an indispensable resource to those responsible for maintaining our nation’s vaccine vigilance.


 * Institute of Medicine (2000). Ending Neglect: The Elimination of Tuberculosis in the United States. Washington, DC, The National Academies Press.

Tuberculosis emerged as an epidemic in the 1600s, began to decline as sanitation improved in the 19th century, and retreated further when effective therapy was developed in the 1950s. TB was virtually forgotten until a recent resurgence in the U.S. and around the world-ominously, in forms resistant to commonly used medicines. What must the nation do to eliminate TB? The distinguished committee from the Institute of Medicine offers recommendations in the key areas of epidemiology and prevention, diagnosis and treatment, funding and organization of public initiatives, and the U.S. role worldwide. The panel also focuses on how to mobilize policy makers and the public to effective action. The book provides important background on the pathology of tuberculosis, its history and status in the U.S., and the public and private response. The committee explains how the U.S. can act with both self-interest and humanitarianism in addressing the worldwide incidence of TB.


 * Institute of Medicine (2000). Gulf War and Health: Volume 1: Depleted Uranium, Sarin, Pyridostigmine Bromide, and Vaccines. Washington, DC, The National Academies Press.
 * Institute of Medicine (2000). Informing the Future: Critical Issues in Health. Washington, DC, The National Academies Press.
 * Institute of Medicine (2000). Urgent Attention Needed to Restore Lapsed Adenovirus Vaccine Availability: A Letter Report. Washington, DC, The National Academies Press.

The Adenovirus is a nonenveloped virus that affects the respiratory tract, the eyes, and the urinary tract. The virus accounts for nearly 10% of respiratory infections in young children and babies. The virus, however, can affect adults as well. The dangers of the virus are that an affected person can either display no symptoms or the most severe of symptoms. Like all many virus that affect humans, a vaccine was created against the Adenovirus. The vaccine created against the adenovirus, however, has become unavailable putting many at risk, including the U.S. military. Urgent Attention Needed to Restore Lapsed Adenovirus Vaccine Availability: A Letter Report presents the Committee on a Strategy for Minimizing the Impact of Naturally Occurring Infectious Diseases of Military Importance: Vaccine Issues in the U.S. Military’s findings and recommendations concerning the lapsed adenovirus vaccine.


 * Institute of Medicine (2000). Vaccines for the 21st Century: A Tool for Decisionmaking. Washington, DC, The National Academies Press.

Vaccines have made it possible to eradicate the scourge of smallpox, promise the same for polio, and have profoundly reduced the threat posed by other diseases such as whooping cough, measles, and meningitis. What is next? There are many pathogens, autoimmune diseases, and cancers that may be promising targets for vaccine research and development. This volume provides an analytic framework and quantitative model for evaluating disease conditions that can be applied by those setting priorities for vaccine development over the coming decades. The committee describes an approach for comparing potential new vaccines based on their impact on morbidity and mortality and on the costs of both health care and vaccine development. The book examines: Lessons to be learned from the polio experience. Scientific advances that set the stage for new vaccines. Factors that affect how vaccines are used in the population. Value judgments and ethical questions raised by comparison of health needs and benefits. The committee provides a way to compare different forms of illness and set vaccine priorities without assigning a monetary value to lives. Their recommendations will be important to anyone involved in science policy and public health planning: policymakers, regulators, health care providers, vaccine manufacturers, and researchers.


 * Institute of Medicine (2001). CDC Anthrax Vaccine Safety; Efficacy Research Program: Interim Report. Washington, DC, The National Academies Press.
 * Institute of Medicine (2001). Emerging Infectious Diseases from the Global to the Local Perspective: A Summary of a Workshop of the Forum on Emerging Infections. Washington, DC, The National Academies Press.

In October 1999, the Forum on Emerging Infections of the Institute of Medicine convened a two-day workshop titled “International Aspects of Emerging Infections.” Key representatives from the international community explored the forces that drive emerging infectious diseases to prominence. Representatives from the Americas, Africa, Asia and the Pacific, and Europe made formal presentations and engaged in panel discussions. Emerging Infectious Diseases from the Global to the Local Perspective includes summaries of the formal presentations and suggests an agenda for future action. The topics addressed cover a wide range of issues, including trends in the incidence of infectious diseases around the world, descriptions of the wide variety of factors that contribute to the emergence and reemergence of these diseases, efforts to coordinate surveillance activities and responses within and across borders, and the resource, research, and international needs that remain to be addressed.


 * Institute of Medicine (2001). Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC, The National Academies Press.

Immunization is widely regarded as one of the most effective and beneficial tools for protecting the public’s health. In the United States, immunization programs have resulted in the eradication of smallpox, the elimination of polio, and the control and near elimination of once-common, often debilitating and potentially life-threatening diseases, including measles, mumps, rubella, diphtheria, pertussis, tetanus, and Haemophilus influenza type b. Along with the benefits of widespread immunization, however, have come concerns about the safety of vaccines. No vaccine is perfectly safe or effective, and vaccines may lead to serious adverse effects in some instances. Furthermore, if a serious illness is observed after vaccination, it is often unclear whether that sequence is coincidental or causal, and it can be difficult to determine the true nature of the relationship, if any, between the vaccination and the illness. Ironically, the successes of vaccine coverage in the United States have made it more difficult for the public to weigh the benefits and complications of vaccines because the now-controlled diseases and their often-serious risks are no longer familiar. However, because vaccines are so widely used-and because state laws require that children be vaccinated before entering daycare and school, in part to protect others-it is essential that safety concerns be fully and carefully studied. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism, the first of a series from the Institute of Medicine (IOM) Immunization Safety Review Committee, presents an assessment of the evidence regarding a hypothesized causal association between the measles-mumps-rubella (MMR) vaccine and autism, an assessment of the broader significance for society of the issues surrounding the MMR-autism hypothesis, and the committee’s conclusions and recommendations based on those assessments.


 * Institute of Medicine (2001). Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders. Washington, DC, The National Academies Press.

In this report, the Immunization Safety Review committee examines the hypothesis of whether or not the use of vaccines containing the preservative thimerosal can cause neurodevelopmental disorders (NDDs), specifically autism, attention deficit/hyperactivity disorder (ADHD), and speech or language delay.


 * Institute of Medicine (2002). The Anthrax Vaccine: Is It Safe? Does It Work? Washington, DC, The National Academies Press.

The vaccine used to protect humans against the anthrax disease, called Anthrax Vaccine Adsorbed (AVA), was licensed in 1970. It was initially used to protect people who might be exposed to anthrax where they worked, such as veterinarians and textile plant workers who process animal hair. When the U. S. military began to administer the vaccine, then extended a plan for the mandatory vaccination of all U. S. service members, some raised concerns about the safety and efficacy of AVA and the manufacture of the vaccine. In response to these and other concerns, Congress directed the Department of Defense to support an independent examination of AVA. The Anthrax Vaccine: Is It Safe? Does It Work? reports the study’s conclusion that the vaccine is acceptably safe and effective in protecting humans against anthrax. The book also includes a description of advances needed in main areas: improving the way the vaccine is now used, expanding surveillance efforts to detect side effects from its use, and developing a better vaccine.


 * Institute of Medicine (2002). Biological Threats and Terrorism: Assessing the Science and Response Capabilities: Workshop Summary. Washington, DC, The National Academies Press.

In the wake of September 11th and recent anthrax events, our nation’s bioterrorism response capability has become an imminent priority for policymakers, researchers, public health officials, academia, and the private sector. In a three-day workshop, convened by the Institute of Medicine’s Forum on Emerging Infections, experts from each of these communities came together to identify, clarify, and prioritize the next steps that need to be taken in order to prepare and strengthen bioterrorism response capabilities. From the discussions, it became clear that of utmost urgency is the need to cast the issue of a response in an appropriate framework in order to attract the attention of Congress and the public in order to garner sufficient and sustainable support for such initiatives. No matter how the issue is cast, numerous workshop participants agreed that there are many gaps in the public health infrastructure and countermeasure capabilities that must be prioritized and addressed in order to assure a rapid and effective response to another bioterrorist attack.


 * Institute of Medicine (2002). Considerations for Viral Disease Eradication: Lessons Learned and Future Strategies: Workshop Summary. Washington, DC, The National Academies Press.

Since smallpox eradication, the science of eradication has changed and with it, our definitions of what diseases are possible to eradicate. However, eradication must not beget complacency. As has been learned from past control or eradication attempts with a variety of viral diseases, from yellow fever to influenza, accidental or intentional reintroduction is a real threat -- one that could strike anywhere and for which we need to be fully prepared. The criteria for assessing eradicability of polio, measles, and other viral infections have been debated extensively. With the elimination and eradication of several viral diseases on the horizon, issues surrounding the cessation of immunization activities become exceedingly important. In an effort to better understand the dynamics of disease eradication and post--immunization policies, the Institute of Medicine Forum on Emerging Infections hosted a two-day workshop (February 1--2, 2001) on The Consequences of Viral Disease Eradication. This book explores the principles underlying the biological challenges, medical interventions, the continuing research agenda, and operational considerations for post--immunization strategies for vaccine--preventable viral diseases, and highlights important efforts that may facilitate wise decision making.


 * Institute of Medicine (2002). The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health: Workshop Summary. Washington, DC, The National Academies Press.

Zoonotic diseases represent one of the leading causes of illness and death from infectious disease. Defined by the World Health Organization, zoonoses are “those diseases and infections that are naturally transmitted between vertebrate animals and man with or without an arthropod intermediate.” Worldwide, zoonotic diseases have a negative impact on commerce, travel, and economies. In most developing countries, zoonotic diseases are among those diseases that contribute significantly to an already overly burdened public health system. In industrialized nations, zoonotic diseases are of particular concern for at-risk groups such as the elderly, children, childbearing women, and immunocompromised individuals. The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health, covers a range of topics, which include: an evaluation of the relative importance of zoonotic diseases against the overall backdrop of emerging infections; research findings related to the current state of our understanding of zoonotic diseases; surveillance and response strategies to detect, prevent, and mitigate the impact of zoonotic diseases on human health; and information about ongoing programs and actions being taken to identify the most important needs in this vital area.


 * Institute of Medicine (2002). Immunization Safety Review: Hepatitis B Vaccine and Demyelinating Neurological Disorders. Washington, DC, The National Academies Press.

Immunization to protect infants and children from vaccine-preventable diseases is one of the greatest achievements of public health. Immunization is not without risks, however. It is well established, for example, that the oral polio vaccine can on rare occasion cause paralytic polio. The Immunization Safety Review Committee was established by the Institute of Medicine (IOM) to evaluate the available evidence on a series of immunization safety concerns. The committee is charged with examining three immunization safety hypotheses each year during the three-year study period (2001- 2003). While all of the committee members share the view that immunization is generally beneficial, none of them has a vested interest in the specific immunization safety issues that come before the group. In this report, which is the fourth in the series, the committee examines the hypothesis that the hepatitis B vaccine increases the risk for demyelinating disorders of the central or peripheral nervous systems, including multiple sclerosis (MS) and Guillain-Barré; syndrome (GBS).


 * Institute of Medicine (2002). Immunization Safety Review: Multiple Immunizations and Immune Dysfunction. Washington, DC, The National Academies Press.

By two years of age, healthy infants in the United States can receive up to 20 vaccinations to protect against 11 diseases. Although most people know that vaccines effectively protect against serious infectious diseases, approximately one-quarter of parents in a recent survey believe that infants get more vaccines than are good for them, and that too many immunizations could overwhelm an infant’s immune system. The Immunization Safety Review Committee reviewed the evidence regarding the hypothesis that multiple immunizations increase the risk for immune dysfunction. Specifically, the committee looked at evidence of potential biological mechanisms and at epidemiological evidence for or against causality related to risk for infections, the autoimmune disease type 1 diabetes, and allergic disorders.


 * Institute of Medicine (2002). Protecting Our Forces: Improving Vaccine Acquisition and Availability in the U.S. Military. Washington, DC, The National Academies Press.

Infectious diseases continue to pose a substantial threat to the operational capacity of military forces. Protecting Our Forces reviews the process by which the U.S. military acquires vaccines to protect its warfighters from natural infectious disease threats. The committee found that poorly aligned acquisition processes and an inadequate commitment of financial resources within the Department of Defense vaccine acquisition process – rather than uncleared scientific or technological hurdles – contribute to the unavailability of some vaccines that could protect military personnel and, implicitly, the welfare and security of the nation. Protecting Our Forces outlines ways in which DoD might strengthen its acquisition process and improve vaccine availability. Recommendations, which include combining all DoD vaccine acquisition responsibilities under a single DoD authority, cover four broad aspects of the acquisition process: (1) organization, authority, and responsibility; (2) program and budget; (3)manufacturing; (4) and the regulatory status of special-use vaccines.


 * Institute of Medicine (2002). Scientific and Policy Considerations in Developing Smallpox Vaccination Options: A Workshop Report. Washington, DC, The National Academies Press.

At the World Health Assembly in May 1980, the World Health Organization declared the world free of smallpox. Smallpox vaccination of civilians is now indicated only for laboratory workers directly involved with smallpox or closely related orthopox viruses. However recent questions raised by the terrorist attacks in fall 2001 have renewed concerns about possible outbreaks of smallpox resulting from its use as a biological weapon. In June 2002, the Institute of Medicine convened a public conference to discuss the scientific, clinical, procedural, and administrative aspects of various immunization strategies. Scientific and Policy Considerations in Developing Smallpox Vaccination Options summarizes the presentations and discussions from this workshop.


 * Institute of Medicine (2002). Setting the Course: A Strategic Vision for Immunization Finance: Part 1: Summary of the Chicago Workshop. Washington, DC, The National Academies Press.

The federal and state partnership in supporting immunization programs that benefit the general population evolved over the last half of the 20th century from a simple cost-sharing arrangement for vaccine purchase for disadvantaged children to a more complicated mix of programs, health care coverage benefits, and public-private partnerships. The mix of financial arrangements that support immunization efforts was the subject of a study by the Institute of Medicine, resulting in the publication of the report Calling the Shots. In June 2001, a group of 50 health officials, public health experts, health care providers, health plan representatives, and community leaders met at the University of Illinois in Chicago to explore the implications of the IOM findings and recommendations for the states of Illinois and Michigan. The one-day workshop was the first in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about future financing strategies for the public health infrastructure that supports immunization efforts. This report of the Chicago workshop summarizes the findings of the IOM study and reviews the challenges that remain in establishing a reliable financial base for the U.S. immunization system. The report high-lights strategies presented by workshop speakers and discussants for achieving immunization goals, including increases in state and federal public health budgets, the addition of quality improvement measures in health plans, performance-based contracting, public policy actions, and the creation of public-private partnerships.


 * Institute of Medicine (2002). Setting the Course: A Strategic Vision for Immunization: Part 2: Summary of the Austin Workshop. Washington, DC, The National Academies Press.

Immunization is essential to disease prevention efforts in public health, but the U.S. health care system faces financial challenges that are affecting the delivery of immunization services. An earlier report from the Institute of Medicine (IOM), Calling the Shots: Immunization Finance Policies and Practices, pointed to the instability of the fundamental infrastructure that supports immunization programs throughout the United States, including growing financial burdens and operational complexities in immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in insurance plans in the public and private health care sectors that create uncertainties regarding coverage of vaccine purchase and service delivery arrangements. In October 2001, a group of about 50 health officials, public health experts, health care providers, health plan representatives and purchasers, state legislative officials, and community leaders met at the Texas Medical Association in Austin to explore the implications of the IOM findings and recommendations for Texas. The 1-day workshop was the second in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about challenges for immunization finance and future strategies for strengthening immunization activities and the public health infrastructure that supports those activities. This report of the Austin workshop summarizes the findings of the previous IOM report and reviews continuing challenges in immunization finance for the nation and for individual states, with a particular focus on Texas. The report also highlights strategies proposed by individual workshop participants that can be used to address those challenges. Several presenters and discussants emphasized that adequate funding is necessary for immunization programs but that financial resources alone are not sufficient to guarantee success. Similarly, they indicated that no single agency or group in the public or the private sector should expect, or should be expected, to solve immunization problems. Speakers from both public and private health agencies observed that collaboration, consultation, and partnership efforts across levels of government and between the public and private sectors are essential.


 * Institute of Medicine (2003). Immunization Safety Review: SV40 Contamination of Polio Vaccine and Cancer. Washington, DC, The National Academies Press.

The Immunization Safety Review Committee was established by the Institute of Medicine (IOM) to evaluate the evidence on possible causal associations between immunizations and certain adverse outcomes, and to then present conclusions and recommendations. The committee’s mandate also includes assessing the broader societal significance of these immunization safety issues. While all the committee members share the view that immunization is generally beneficial, none of them has a vested interest in the specific immunization safety issues that come before the group. The committee reviews three immunization safety review topics each year, addressing each one at a time. In this fifth report in a series, the committee examines the hypothesis that exposure to polio vaccine contaminated with simian virus 40 (SV40), a virus that causes inapparent infection in some monkeys, can cause certain types of cancer.


 * Institute of Medicine (2003). Immunization Safety Review: Vaccinations and Sudden Unexpected Death in Infancy. Washington, DC, The National Academies Press.

With current recommendations calling for infants to receive multiple doses of vaccines during their first year of life and with sudden infant death syndrome (SIDS) the most frequent cause of death during the postneonatal period, it is important to respond to concerns that vaccination might play a role in sudden unexpected infant death. The committee reviewed epidemiologic evidence focusing on three outcomes: SIDS, all SUDI (sudden unexpected death in infancy), and neonatal death (infant death, whether sudden or not, during the first 4 weeks of life). Based on this review, the committee concluded that the evidence favors rejection of a causal relationship between some vaccines and SIDS; and that the evidence is inadequate to accept or reject a causal relationship between other vaccines and SIDS, SUDI, or neonatal death. The evidence regarding biological mechanisms is essentially theoretical, reflecting in large measure the lack of knowledge concerning the pathogenesis of SIDS.


 * Institute of Medicine (2003). Informing the Future: Critical Issues in Health: Second Edition. Washington, DC, The National Academies Press.
 * Institute of Medicine (2003). The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. Washington, DC, The National Academies Press.

The resistance topic is timely given current events. The emergence of mysterious new diseases, such as SARS, and the looming threat of bioterrorist attacks remind us of how vulnerable we can be to infectious agents. With advances in medical technologies, we have tamed many former microbial foes, yet with few new antimicrobial agents and vaccines in the pipeline, and rapidly increasing drug resistance among infectious microbes, we teeter on the brink of loosing the upperhand in our ongoing struggle against these foes, old and new. The Resistance Phenomenon in Microbes and Infectious Disease Vectors examines our understanding of the relationships among microbes, disease vectors, and human hosts, and explores possible new strategies for meeting the challenge of resistance.


 * Institute of Medicine (2003). Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report 2. Washington, DC, The National Academies Press.
 * Institute of Medicine (2003). Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report 3. Washington, DC, The National Academies Press.
 * Institute of Medicine (2003). Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report #1. Washington, DC, The National Academies Press.
 * Institute of Medicine (2003). Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report #4. Washington, DC, The National Academies Press.
 * Institute of Medicine (2003). Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report #5. Washington, DC, The National Academies Press.
 * Institute of Medicine (2003). Setting the Course: A Strategic Vision for Immunization: Part 3: Summary of the Los Angeles Workshop. Washington, DC, The National Academies Press.

Immunization is essential to disease prevention efforts in public health, but the nation’s immunization system faces financing challenges that are affecting the delivery of services. A 2000 report from the Institute of Medicine (IOM), Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000), pointed to the instability of the fundamental infrastructure that supports immunization programs throughout the United States, including unpredictable federal funding levels, growing financial burdens and operational complexities in immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in coverage plans in the public and private health care sectors that create uncertainties regarding vaccine purchase and service delivery arrangements. In January 2002, health officials, public health experts, health care providers, health plan representatives, health care purchasers, and community leaders met at the University of California at Los Angeles to explore the implications of the IOM findings and recommendations for California in general and for Los Angeles and San Diego County in particular. The one-day workshop was the third in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about challenges for immunization finance and future financing strategies for immunization activities and the public health infrastructure that supports those activities. This report of the Los Angeles workshop summarizes the findings of the IOM study, reviews progress in responding to the IOM recommendations at the federal level, and highlights continuing challenges in immunization finance for the nation and at the state and local levels in California.


 * Institute of Medicine (2003). Setting the Course: A Strategic Vision for Immunization: Part 4: Summary of the Washington, D.C., Workshop. Washington, DC, The National Academies Press.

In 2000, the Institute of Medicine (IOM) produced a report Calling the Shots: Immunization Finance Policies and Practices (IOM, 2000a) that illustrated the uncertainties and instability of the public health infrastructure that supports U.S. immunization programs. The IOM report proposed several strategies to address these concerns and to strengthen the immunization infrastructure. In March 2002, a group of 50 health officials, public health experts, health care providers, health plan representatives, health care purchasers, and community leaders met at The National Academies in Washington, DC to explore the implications of the IOM findings and recommendations for the federal and state governments. Private health plans and business sector representatives also participated in the meeting to discuss their role in fostering high levels of immunization coverage. The one-day workshop was the fourth and last in a series of meetings organized by IOM with support from the CDC to foster informed discussions about future financing strategies for immunization and the public health infrastructure. This report of the Washington, DC workshop summarizes the findings of the IOM study, reviews the implementation of the IOM recommendations, and highlights continuing immunization finance challenges for the nation as a whole as well as state and local health departments.


 * Institute of Medicine (2004). Financing Vaccines in the 21st Century: Assuring Access and Availability. Washington, DC, The National Academies Press.

The national immunization system has achieved high levels of immunization, particularly for children. However, this system faces difficult challenges for the future. Significant disparities remain in assuring access to recommended vaccines across geographic and demographic populations. These disparities result, in part, from fragmented public–private financing in which a large number of children and adults face limited access to immunization services. Access for adults lags well behind that of children, and rates of immunizations for those who are especially vulnerable because of chronic health conditions such as diabetes or heart and lung disease, remain low. Financing Vaccines in the 21st Century: Assuring Access and Availability addresses these challenges by proposing new strategies for assuring access to vaccines and sustaining the supply of current and future vaccines. The book recommends changes to the Advisory Committee on Immunization Practices (ACIP)-the entity that currently recommends vaccines-and calls for a series of public meetings, a post-implementation evaluation study, and development of a research agenda to facilitate implementation of the plan.


 * Institute of Medicine (2004). Immunization Safety Review: Influenza Vaccines and Neurological Complications. Washington, DC, The National Academies Press.

Infection with the influenza virus can have a serious effect on the health of people of all ages, although it is particularly worrisome for infants, the elderly, and people with underlying heart or lung problems. A vaccine exists (the “flu” shot) that can greatly decrease the impact of influenza. Because the strains of virus that are expected to cause serious illness and death are slightly different every year, the vaccine is also slightly different every year and it must be given every year, unlike other vaccines. The Immunization Safety Review committee reviewed the data on influenza vaccine and neurological conditions and concluded that the evidence favored rejection of a causal relationship between influenza vaccines and exacerbation of multiple sclerosis. For the other neurological conditions studied, the committee concluded the evidence about the effects of influenza vaccine is inadequate to accept or reject a causal relationship. The committee also reviewed theories on how the influenza vaccine could damage the nervous system. The evidence was at most weak that the vaccine could act in humans in ways that could lead to these neurological problems.


 * Institute of Medicine (2004). Immunization Safety Review: Vaccines and Autism. Washington, DC, The National Academies Press.

This eighth and final report of the Immunization Safety Review Committee examines the hypothesis that vaccines, specifically the measles-mumps-rubella (MMR) vaccine and thimerosal-containing vaccines, are causally associated with autism. The committee reviewed the extant published and unpublished epidemiological studies regarding causality and studies of potential biologic mechanisms by which these immunizations might cause autism. Immunization Safety Review: Vaccines and Autism finds that the body of epidemiological evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism. The book further finds that potential biological mechanisms for vaccine-induced autism that have been generated to date are only theoretical. It recommends a public health response that fully supports an array of vaccine safety activities and recommends that available funding for autism research be channeled to the most promising areas. The book makes additional recommendations regarding surveillance and epidemiological research, clinical studies, and communication related to these vaccine safety concerns.


 * Institute of Medicine (2004). Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington, DC, The National Academies Press.

The emergence of severe acute respiratory syndrome (SARS) in late 2002 and 2003 challenged the global public health community to confront a novel epidemic that spread rapidly from its origins in southern China until it had reached more than 25 other countries within a matter of months. In addition to the number of patients infected with the SARS virus, the disease had profound economic and political repercussions in many of the affected regions. Recent reports of isolated new SARS cases and a fear that the disease could reemerge and spread have put public health officials on high alert for any indications of possible new outbreaks. This report examines the response to SARS by public health systems in individual countries, the biology of the SARS coronavirus and related coronaviruses in animals, the economic and political fallout of the SARS epidemic, quarantine law and other public health measures that apply to combating infectious diseases, and the role of international organizations and scientific cooperation in halting the spread of SARS. The report provides an illuminating survey of findings from the epidemic, along with an assessment of what might be needed in order to contain any future outbreaks of SARS or other emerging infections.


 * Institute of Medicine (2004). Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation: Letter Report #6. Washington, DC, The National Academies Press.
 * Institute of Medicine (2004). Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance. Washington, DC, The National Academies Press.

For more than 50 years, low-cost antimalarial drugs silently saved millions of lives and cured billions of debilitating infections. Today, however, these drugs no longer work against the deadliest form of malaria that exists throughout the world. Malaria deaths in sub-Saharan Africa—currently just over one million per year—are rising because of increased resistance to the old, inexpensive drugs. Although effective new drugs called “artemisinins” are available, they are unaffordable for the majority of the affected population, even at a cost of one dollar per course. Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance examines the history of malaria treatments, provides an overview of the current drug crisis, and offers recommendations on maximizing access to and effectiveness of antimalarial drugs. The book finds that most people in endemic countries will not have access to currently effective combination treatments, which should include an artemisinin, without financing from the global community. Without funding for effective treatment, malaria mortality could double over the next 10 to 20 years and transmission will intensify.


 * Institute of Medicine (2005). Informing the Future: Critical Issues in Health, Third Edition. Washington, DC, The National Academies Press.
 * Institute of Medicine (2005). The Smallpox Vaccination Program: Public Health in an Age of Terrorism. Washington, DC, The National Academies Press.

December 13, 2002, the president of the United States announced that smallpox vaccination would be offered to some categories of civilians and administered to members of the military and government representatives in high-risk areas of the world. The events that precipitated that historic announcement included a series of terrorist attacks during the 1990s, which culminated in the catastrophic events of 2001. Although preparedness for deliberate attacks with biologic weapons was already the subject of much public health planning, meetings, and publications as the twentieth century neared its end, the events of 2001 led to a steep rise in bioterrorism-related government policies and funding, and in state and local preparedness activities, for example, in public health, health care, and the emergency response and public safety communities. The national smallpox vaccination program is but one of many efforts to improve readiness to respond to deliberate releases of biologic agents. The Institute of Medicine (IOM) Committee on Smallpox Vaccination Program Implementation was convened in October 2002 at the request of the Centers for Disease Control and Prevention (CDC), the federal agency charged with implementing the government’s policy of providing smallpox vaccine first to public health and health care workers on response teams, then to all interested health care workers and other first responders, and finally to members of the general public who might insist on receiving the vaccine. The committee was charged with providing “advice to the CDC and the program investigators on selected aspects of the smallpox program implementation and evaluation.” The committee met six times over 19 months and wrote a series of brief “letter” reports. The Smallpox Vaccination Program: Public Health in an Age of Terrorism constitutes the committee’s seventh and final report, and the committee hopes that it will fulfill three purposes: 1) To serve as an archival document that brings together the six reports addressed to Julie Gerberding, director of CDC, and previously released on line and as short, unbound papers; 2) To serve as a historical document that summarizes milestones in the smallpox vaccination program, and ; 3) To comment on the achievement of overall goals of the smallpox vaccination program (in accordance with the last item in the charge), including lessons learned from the program.


 * Institute of Medicine (2005). The Threat of Pandemic Influenza: Are We Ready? Workshop Summary. Washington, DC, The National Academies Press.

Public health officials and organizations around the world remain on high alert because of increasing concerns about the prospect of an influenza pandemic, which many experts believe to be inevitable. Moreover, recent problems with the availability and strain-specificity of vaccine for annual flu epidemics in some countries and the rise of pandemic strains of avian flu in disparate geographic regions have alarmed experts about the world’s ability to prevent or contain a human pandemic. The workshop summary, The Threat of Pandemic Influenza: Are We Ready? addresses these urgent concerns. The report describes what steps the United States and other countries have taken thus far to prepare for the next outbreak of “killer flu.” It also looks at gaps in readiness, including hospitals’ inability to absorb a surge of patients and many nations’ incapacity to monitor and detect flu outbreaks. The report points to the need for international agreements to share flu vaccine and antiviral stockpiles to ensure that the 88 percent of nations that cannot manufacture or stockpile these products have access to them. It chronicles the toll of the H5N1 strain of avian flu currently circulating among poultry in many parts of Asia, which now accounts for the culling of millions of birds and the death of at least 50 persons. And it compares the costs of preparations with the costs of illness and death that could arise during an outbreak.


 * Institute of Medicine (2005). Vaccine Safety Research, Data Access, and Public Trust. Washington, DC, The National Academies Press.

The Vaccine Safety Datalink (VSD) is a large, linked database of patient information that was developed jointly by CDC and several private managed care organizations in 1991. It includes data on vaccination histories, health outcomes, and characteristics of more than 7 million patients of eight participating health organizations. Researchers from CDC and the managed care groups have used VSD information to study whether health problems are associated with vaccinations. The subsequent VSD data sharing program was launched in 2002 to allow independent, external researchers access to information in the database. In this report, the committee that was asked to review aspects of this program recommends that two new oversight groups are needed to ensure that the policies and procedures of the VSD and its data sharing program are implemented as fairly and openly as possible.


 * Institute of Medicine (2006). Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program. Washington, DC, The National Academies Press.

Malaria is an infectious disease common to several parts of the world, including Africa, northern South America, and Asia. During their service in the military, U.S. active members may be sent to any part of the world, including parts of the world where Malaria is an issue. In Liberia in 2003, for example, there was a 28 percent attack rate in Marines who spent a short time ashore, and half of the 80 Marines affected needed to be evacuated to Germany. This was not only costly to the U.S. military but dangerous as well. To fight against this disease, there exists a Malaria Vaccine program in the U.S. military. However, there exists a variety of potential vaccine targets for the most severe and important form of malaria; malaria from the species Plasmodium falciparum. Issues also arise with the fact that there are three possible stages to create vaccines against—preerythrocytic, blood, or transmission. The Department of Defense (DoD), through the commanding general of the U.S. Army Medical Research and Materiel Command (USAMRMC), requested that the Institute of Medicine (IOM) conduct a programmatic review of the military Plasmodium falciparum malaria vaccine research and development program. There was to be a focus on vaccine against the preerythrocytic and blood stages. The IOM formed a committee of 11 experts with collective expertise in malaria vaccine research, parasite immunology, malarial biology, clinical trials and regulatory affairs, industrial and public-sector vaccine development, biologic products research and development (vaccinology), military research and development programs, tropical medicine, and public health. The committee focused different tasks including determining whether the DoD malaria vaccine research and development program is scientifically sound and able to achieve the vaccine program objectives within specified timelines, recommending how to overcome significant, identified barriers, and identifying major strategic goals and timelines based on the material received and presentations made by the DoD’s program representatives. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program presents the committee’s findings, current malaria vaccines, and recommendations for the development of the U.S. Military vaccine research.


 * Institute of Medicine (2006). Ensuring an Infectious Disease Workforce: Education and Training Needs for the 21st Century: Workshop Summary. Washington, DC, The National Academies Press.

The Forum on Microbial Threats (previously named the Forum on Emerging Infections) was created in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The goal of the Forum is to provide structured opportunities for representatives from academia, industry, professional and interest groups, and government to examine and discuss scientific and policy issues that are of shared interest and that are specifically related to research and prevention, detection, and management of emerging infectious diseases. In accomplishing this task, the Forum provides the opportunity to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them directly; hence, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its strengths are the diversity of its membership and the contributions of individual members expressed throughout the activities of the Forum. Recent increased attention to both United States and international public health systems as well as the medical research and treatment infrastructure has revealed significant deficiencies in their capacity to respond to infectious diseases. Medical and public health professionals may be poorly equipped to detect, diagnose, and treat common infectious diseases as well as those diseases that pose an unexpected threat. The need for the development of domestic and international training programs in the expanding field of emerging and reemerging infectious diseases is well recognized. Well-trained infectious disease professionals form the basis of a strong national healthcare system. The Forum on Emerging Infections (now renamed the Forum on Microbial Threats) convened a 2-day workshop discussion—the subject of this summary—to examine the education and training needs to ensure an adequate infectious diseases workforce. The workshop reviewed trends in research training programs and discussed the requirements for establishing successful educational initiatives and training programs to ensure a competent and prepared workforce for current and future challenges in infectious diseases. Some key disciplines explored as case-study examinations included infectious disease epidemiology, vaccinology, vector biology, and public health laboratorians.


 * Institute of Medicine (2006). The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities: Workshop Summary. Washington, DC, The National Academies Press.

Globalization is by no means a new phenomenon; transcontinental trade and the movement of people date back at least 2,000 years, to the era of the ancient Silk Road trade route. The global spread of infectious disease has followed a parallel course. Indeed, the emergence and spread of infectious disease are, in a sense, the epitome of globalization. Although some experts mark the fall of the Berlin Wall as the beginning of this new era of globalization, others argue that it is not so new. The future of globalization is still in the making. Despite the successful attempts of the developed world during the course of the last century to control many infectious diseases and even to eradicate some deadly afflictions, 13 million people worldwide still die from such diseases every year. On April 16 and 17, 2002, the Forum on Emerging Infections held a working group discussion on the influence of globalization on the emergence and control of infectious diseases. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop. The Impact of Globalization on Infectious Disease Emergence and Control report summarizes the presentations and discussions related to the increasing cross-border and cross-continental movements of people and how this could exacerbate the emergence and global spread of infectious diseases. This report also summarizes the means by which sovereign states and nations must adopt a global public health mind-set and develop a new organizational framework to maximize the opportunities and overcome the challenges created by globalization and build the necessary capacity to respond effectively to emerging infectious disease threats.


 * Institute of Medicine (2007). Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary. Washington, DC, The National Academies Press.

In recent public workshops and working group meetings, the Forum on Microbial Threats of the Institute of Medicine (IOM) has examined a variety of infectious disease outbreaks with pandemic potential, including those caused by influenza (IOM, 2005) and severe acute respiratory syndrome (SARS) (IOM, 2004). Particular attention has been paid to the potential pandemic threat posed by the H5N1 strain of avian influenza, which is now endemic in many Southeast Asian bird populations. Since 2003, the H5N1 subtype of avian influenza has caused 185 confirmed human deaths in 11 countries, including some cases of viral transmission from human to human (WHO, 2007). But as worrisome as these developments are, at least they are caused by known pathogens. The next pandemic could well be caused by the emergence of a microbe that is still unknown, much as happened in the 1980s with the emergence of the human immunodeficiency virus (HIV) and in 2003 with the appearance of the SARS coronavirus. Previous Forum meetings on pandemic disease have discussed the scientific and logistical challenges associated with pandemic disease recognition, identification, and response. Participants in these earlier meetings also recognized the difficulty of implementing disease control strategies effectively. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary as a factual summary of what occurred at the workshop.


 * Institute of Medicine (2007). Informing the Future: Critical Issues in Health: Fourth Edition. Washington, DC, The National Academies Press.
 * Institute of Medicine (2008). Addressing the Barriers to Pediatric Drug Development: Workshop Summary. Washington, DC, The National Academies Press.

Decades of research have demonstrated that children do not respond to medications in the same way as adults. Differences between children and adults in the overall response to medications are due to profound anatomical, physiological, and developmental differences. Although few would argue that children should receive medications that have not been adequately tested for safety and efficacy, the majority of drugs prescribed for children--50 to 75 percent--have not been tested in pediatric populations. Without adequate data from such testing, prescribing drugs appropriately becomes challenging for clinicians treating children, from infancy through adolescence. Addressing the Barriers to Pediatric Drug Development is the summary of a workshop, held in Washington, D.C. on June 13, 2006, that was organized to identify barriers to the development and testing of drugs for pediatric populations, as well as ways in which the system can be improved to facilitate better treatments for children.


 * Institute of Medicine (2008). Autism and the Environment: Challenges and Opportunities for Research: Workshop Proceedings. Washington, DC, The National Academies Press.

Autism spectrum disorders (ASD) constitute a major public health problem, affecting one in every 150 children and their families. Unfortunately, there is little understanding of the causes of ASD, and, despite their broad societal impact, many people believe that the overall research program for autism is incomplete, particularly as it relates to the role of environmental factors. The Institute of Medicine’s Forum on Neuroscience and Nervous System Disorders, in response to a request from the U.S. Secretary of Health and Human Services, hosted a workshop called “Autism and the Environment: Challenges and Opportunities for Research.” The focus was on improving the understanding of the ways in which environmental factors such as chemicals, infectious agents, or physiological or psychological stress can affect the development of the brain. Autism and the Environment documents the concerted effort which brought together the key public and private stakeholders to discuss potential ways to improve the understanding of the ways that environmental factors may affect ASD. The presentations and discussions from the workshop that are described in this book identify a number of promising directions for research on the possible role of different environmental agents in the etiology of autism.


 * Institute of Medicine (2008). Initial Guidance for an Update of the National Vaccine Plan: A Letter Report to the National Vaccine Program Office. Washington, DC, The National Academies Press.

This book is the Institute of Medicine’s response to the first part of the statement of task asking for a review of the 1994 National Vaccine Plan. The Committee on the Review of Priorities in the National Vaccine Plan reviewed the goals, objectives, strategies, and anticipated outcomes presented in the plan; their findings are contained in this book. In the first section of the book, the committee examines what has changed in the broader social, policy, and economic context of vaccine development and immunization, and highlights several areas where noteworthy progress has been made, particularly by federal agencies. The committee acknowledges that progress in developing and delivering vaccines has benefited from essential contributions by other stakeholders, including researchers, manufacturers, state and local public health agencies, and health care providers. In the second section of the book, the committee uses what it learned from reviewing the 1994 plan and the process of preparing it to distill key elements. Based on these elements, the committee offers guidance to NVPO and its partners on developing the update to the national vaccine plan.


 * Institute of Medicine (2008). Vector-Borne Diseases: Understanding the Environmental, Human Health, and Ecological Connections: Workshop Summary. Washington, DC, The National Academies Press.

Vector-borne infectious diseases, such as malaria, dengue fever, yellow fever, and plague, cause a significant fraction of the global infectious disease burden; indeed, nearly half of the world’s population is infected with at least one type of vector-borne pathogen (CIESIN, 2007; WHO, 2004a). Vector-borne plant and animal diseases, including several newly recognized pathogens, reduce agricultural productivity and disrupt ecosystems throughout the world. These diseases profoundly restrict socioeconomic status and development in countries with the highest rates of infection, many of which are located in the tropics and subtropics. Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and allows them to present their beliefs about which areas may merit further attention. These proceedings summarize only the statements of participants in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation. Vector-Borne Diseases : Understanding the Environmental, Human Health, and Ecological Connections, Workshop Summary (Forum on Microbial Threats) summarizes this workshop.


 * Institute of Medicine (2009). Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge: Workshop Summary. Washington, DC, The National Academies Press.

Tuberculosis is one of the leading causes of death in the world today, with 4,500 people dying from the disease every day. Many cases of TB can be cured by available antibiotics, but some TB is resistant to multiple drugs--a major and growing threat worldwide. The Institute of Medicine’s Forum on Drug Discovery, Development, and Translation hosted a workshop on November 5, 2008, to address the mounting concern of drug-resistant TB. The session brought together a wide range of international experts to discuss what is known and not known about this growing threat, and to explore possible solutions.


 * Institute of Medicine (2009). Informing the Future: Critical Issues in Health, Fifth Edition. Washington, DC, The National Academies Press.

Today, perhaps more than ever, health care is a key item on the nation’s agenda. Government policy makers, health professionals, scientists, industrial and civic leaders, patient advocates, and private citizens across the social spectrum are focusing on how best to obtain a high-quality health system that is efficient and affordable in its operation and that functions well for everyone. The Institute of Medicine (IOM) regularly considers this challenge from a variety of perspectives. Recent efforts have focused on improving the organization and operation of the nation’s largest health agency; working to assess what diagnostic, therapeutic, and preventive services work best; gauging the overall health of the nation’s population; and identifying ways to build an even stronger foundation of evidence-based medicine that effectively captures the promise of scientific discovery and technological innovation and enables doctors, nurses, and other health professionals to provide the right care for the right patient at the right time. The body of this book illustrates the work of IOM committees in selected, major areas in recent years, followed by a description of IOM’s convening and collaborative activities and fellowship programs. The last section provides a comprehensive bibliography of IOM reports published since 2007.


 * Institute of Medicine (2009). Live Variola Virus: Considerations for Continuing Research. Washington, DC, The National Academies Press.

Smallpox was a devastating disease that decimated human populations for centuries, and its eradication in 1980 was a monumental achievement for the global health community. Since then the remaining known strains of its causative agent, variola virus, have been contained in two World Health Organization (WHO)-approved repositories. In 1999, the World Health Assembly (WHA) debated the issue of destroying these remaining strains. Arguments were presented on the need to retain the live virus for use in additional important research, and the decision to destroy the virus was deferred until this research could be completed. In that same year, the Institute of Medicine (IOM) convened a consensus committee to explore scientific needs for the live virus. In the ten years since the first IOM report, the scientific, political, and regulatory environments have changed. In this new climate, the IOM was once again tasked to consider scientific needs for live variola virus. The committee evaluated the scientific need for live variola virus in four areas: development of therapeutics, development of vaccines, genomic analysis, and discovery research.


 * Institute of Medicine (2009). The U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors. Washington, DC, The National Academies Press.

Health is a highly valued, visible, and concrete investment that has the power to both save lives and enhance the credibility of the United States in the eyes of the world. While the United States has made a major commitment to global health, there remains a wide gap between existing knowledge and tools that could improve health if applied universally, and the utilization of these known tools across the globe. The U.S. Commitment to Global Health concludes that the U.S. government and U.S.-based foundations, universities, nongovernmental organizations, and commercial entities have an opportunity to improve global health. The book includes recommendations that these U.S. institutions increase the utilization of existing interventions to achieve significant health gains; generate and share knowledge to address prevalent health problems in disadvantaged countries; invest in people, institutions, and capacity building with global partners; increase the quantity and quality of U.S. financial commitments to global health; and engage in respectful partnerships to improve global health. In doing so, the U.S. can play a major role in saving lives and improving the quality of life for millions around the world.


 * Institute of Medicine (2010). The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC, The National Academies Press.

In March and early April 2009, a new, swine-origin 2009-H1N1 influenza A virus emerged in Mexico and the United States. During the first few weeks of surveillance, the virus spread by human-to-human transmission worldwide to over 30 countries. On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. By October 30, 2009, the H1N1 influenza A had spread to 191 countries and resulted in 5,700 fatalities. A national emergency was declared in the United States and the swine flu joined SARS and the avian flu as pandemics of the 21st century. Vaccination is currently available, but in limited supply, and with a 60 percent effectiveness rate against the virus. The story of how this new influenza virus spread out of Mexico to other parts of North America and then on to Europe, the Far East, and now Australia and the Pacific Rim countries has its origins in the global interconnectedness of travel, trade, and tourism. Given the rapid spread of the virus, the international scientific, public health, security, and policy communities had to mobilize quickly to characterize this unique virus and address its potential effects. The World Health Organization and Centers for Disease Control have played critical roles in the surveillance, detection and responses to the H1N1 virus. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions aimed to examine the evolutionary origins of the H1N1 virus and evaluate its potential public health and socioeconomic consequences, while monitoring and mitigating the impact of a fast-moving pandemic. The rapporteurs for this workshop reported on the need for increased and geographically robust global influenza vaccine production capacities; enhanced and sustained interpandemic demand for seasonal influenza vaccines; clear “triggers” for pandemic alert levels; and accelerated research collaboration on new vaccine manufacturing techniques. This book will be an essential guide for healthcare professionals, policymakers, drug manufacturers and investigators.


 * Institute of Medicine (2010). Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C. Washington, DC, The National Academies Press.

The global epidemic of hepatitis B and C is a serious public health problem. Hepatitis B and C are the major causes of chronic liver disease and liver cancer in the world. In the next 10 years, 150,000 people in the United States will die from liver disease or liver cancer associated with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Today, between 800,000 and 1.4 million people in the United States have chronic hepatitis B and between 2.7 and 3.9 million have chronic hepatitis C. People most at risk for hepatitis B and C often are the least likely to have access to medical services. Reducing the rates of illness and death associated with these diseases will require greater awareness and knowledge among health care workers, improved identification of at-risk people, and improved access to medical care. Hepatitis B is a vaccine-preventable disease. Although federal public health officials recommend that all newborns, children, and at-risk adults receive the vaccine, about 46,000 new acute cases of the HBV infection emerge each year, including 1,000 in infants who acquire the infection during birth from their HBV-positive mothers. Unfortunately, there is no vaccine for hepatitis C, which is transmitted by direct exposure to infectious blood. Hepatitis and Liver Cancer identifies missed opportunities related to the prevention and control of HBV and HCV infections. The book presents ways to reduce the numbers of new HBV and HCV infections and the morbidity and mortality related to chronic viral hepatitis. It identifies priorities for research, policy, and action geared toward federal, state, and local public health officials, stakeholder, and advocacy groups and professional organizations.


 * Institute of Medicine (2010). Infectious Disease Movement in a Borderless World: Workshop Summary. Washington, DC, The National Academies Press.

Modern transportation allows people, animals, and plants--and the pathogens they carry--to travel more easily than ever before. The ease and speed of travel, tourism, and international trade connect once-remote areas with one another, eliminating many of the geographic and cultural barriers that once limited the spread of disease. Because of our global interconnectedness through transportation, tourism and trade, infectious diseases emerge more frequently; spread greater distances; pass more easily between humans and animals; and evolve into new and more virulent strains. The IOM’s Forum on Microbial Threats hosted the workshop “Globalization, Movement of Pathogens (and Their Hosts) and the Revised International Health Regulations” December 16-17, 2008 in order to explore issues related to infectious disease spread in a “borderless” world. Participants discussed the global emergence, establishment, and surveillance of infectious diseases; the complex relationship between travel, trade, tourism, and the spread of infectious diseases; national and international policies for mitigating disease movement locally and globally; and obstacles and opportunities for detecting and containing these potentially wide-reaching and devastating diseases. This document summarizes the workshop.


 * Institute of Medicine (2010). Medical Countermeasures Dispensing: Emergency Use Authorization and the Postal Model: Workshop Summary. Washington, DC, The National Academies Press.

During public health emergencies such as terrorist attacks or influenza outbreaks, the public health system’s ability to save lives could depend on dispensing medical countermeasures such as antibiotics, antiviral medications, and vaccines to a large number of people in a short amount of time. The IOM’s Forum on Medical and Public Health Preparedness for Catastrophic Events held a workshop on November 18, 2009, to provide an overview of current threats, recent progress made in the public health system for distributing and dispensing countermeasures, and remaining vulnerabilities.


 * Institute of Medicine (2010). Priorities for the National Vaccine Plan. Washington, DC, The National Academies Press.

Vaccination is a fundamental component of preventive medicine and public health. The use of vaccines to prevent infectious diseases has resulted in dramatic decreases in disease, disability, and death in the United States and around the world. The current political, economic, and social environment presents both opportunities for and challenges to strengthening the U.S. system for developing, manufacturing, regulating, distributing, funding, and administering safe and effective vaccines for all people. Priorities for the National Vaccine Plan examines the extraordinarily complex vaccine enterprise, from research and development of new vaccines to financing and reimbursement of immunization services. Priorities for the National Vaccine Plan examines the extraordinarily complex vaccine enterprise, from research and development of new vaccines to financing and reimbursement of immunization services. The book makes recommendations about priority actions in the update to the National Vaccine Plan that are intended to achieve the objectives of disease prevention and enhancement of vaccine safety. It is centered on the plan’s five goals in the areas of vaccine development, safety, communication, supply and use, and global health.


 * Institute of Medicine (2010). The Public Health Emergency Medical Countermeasures Enterprise: Innovative Strategies to Enhance Products from Discovery Through Approval: Workshop Summary. Washington, DC, The National Academies Press.

During public health emergencies such as pandemic influenza outbreaks or terrorist attacks, effective vaccines, drugs, diagnostics, and other medical countermeasures are essential to protecting national security and the public’s well-being. The Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)--a partnership among federal, state, and local governments; industry; and academia--is at the forefront of the effort to develop and manufacture these countermeasures. However, despite the PHEMCE’s many successes, there are still serious challenges to overcome. Government-funded medical research is not always focused on countermeasures for the most serious potential threats, and it is difficult to engage pharmaceutical and biotechnology companies to develop and manufacture medical countermeasures that have a limited commercial market. At the request of the Secretary of the U.S. Department of Health and Human Services and the Assistant Secretary for Preparedness and Response, the IOM held a workshop February 22-24, 2010, to address challenges facing the PHEMCE. Workshop participants discussed federal policies and procedures affecting the research, development, and approval of medical countermeasures and explored opportunities to improve the process and protect Americans’ safety and health.


 * Institute of Medicine (2011). Advancing Regulatory Science for Medical Countermeasure Development: Workshop Summary. Washington, DC, The National Academies Press.

Whether or not the United States has safe and effective medical countermeasures--such as vaccines, drugs, and diagnostic tools--available for use during a disaster can mean the difference between life and death for many Americans. The Food and Drug Administration (FDA) and the scientific community at large could benefit from improved scientific tools and analytic techniques to undertake the complex scientific evaluation and decision making needed to make essential medical countermeasures available. At the request of FDA, the Institute of Medicine (IOM) held a workshop to examine methods to improve the development, evaluation, approval, and regulation of medical countermeasures. During public health emergencies such as influenza or chemical, biological, radiological/nuclear (CBRN) attacks, safe and effective vaccines, treatments, and other medical countermeasures are essential to protecting national security and the well being of the public. Advancing Regulatory Science for Medical Countermeasure Development examines current medical countermeasures, and investigates the future of research and development in this area. Convened on March 29-30, 2011, this workshop identified regulatory science tools and methods that are available or under development, as well as major gaps in currently available regulatory science tools. Advancing Regulatory Science for Medical Countermeasure Development is a valuable resource for federal agencies including the Food and Drug Administration (FDA), the Department of Health and Human Services (HHS), the Department of Defense (DoD), as well as health professionals, and public and private health organizations.


 * Institute of Medicine (2011). The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies. Washington, DC, The National Academies Press.

Neglected tropical diseases (NTDs) afflict more than 1.4 billion people, many of whom live on less than $1.25 a day. While there are effective ways to manage NTDs, policy-makers and funders have only recently begun to recognize the economic and public health importance of controlling NTDs. The IOM’s Forum on Microbial Threats held a workshop September 21-22, 2010, to discuss the science of and policy surrounding NTDs.


 * Institute of Medicine (2011). Clinical Preventive Services for Women: Closing the Gaps. Washington, DC, The National Academies Press.

Women suffer disproportionate rates of chronic disease and disability from some conditions, and often have high out-of-pocket health care costs. The passage of the Patient Protection and Affordable Care Act of 2010 (ACA) provides the United States with an opportunity to reduce existing health disparities by providing an unprecedented level of population health care coverage. The expansion of coverage to millions of uninsured Americans and the new standards for coverage of preventive services that are included in the ACA can potentially improve the health and well-being of individuals across the United States. Women in particular stand to benefit from these additional preventive health services. Clinical Preventive Services for Women reviews the preventive services that are important to women’s health and well-being. It recommends that eight preventive health services for women be added to the services that health plans will cover at no cost. The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The services include improved screening for cervical cancer, sexually transmitted infections, and gestational diabetes; a fuller range of contraceptive education, counseling, methods, and services; services for pregnant women; at least one well-woman preventive care visit annually; and screening and counseling for interpersonal and domestic violence, among others. Clinical Preventive Services for Women identifies critical gaps in preventive services for women as well as measures that will further ensure optimal health and well-being. It can serve as a comprehensive guide for federal government agencies, including the Department of Health and Human Services and the Center for Disease Control and Prevention; state and local government agencies; policy makers; health care professionals; caregivers, and researchers.


 * Institute of Medicine (2011). Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes: Workshop Report. Washington, DC, The National Academies Press.

A single tick bite can have debilitating consequences. Lyme disease is the most common disease carried by ticks in the United States, and the number of those afflicted is growing steadily. If left untreated, the diseases carried by ticks--known as tick-borne diseases--can cause severe pain, fatigue, neurological problems, and other serious health problems. The Institute of Medicine held a workshop October 11-12, 2010, to examine the state of the science in Lyme disease and other tick-borne diseases.


 * Institute of Medicine (2011). Informing the Future: Critical Issues in Health, Sixth Edition. Washington, DC, The National Academies Press.

This report illustrates the work of IOM committees in selected, major areas in recent years, followed by a description of IOM’s convening and collaborative activities and fellowship programs. The last section provides a comprehensive bibliography of IOM reports published since 2007.


 * Institute of Medicine (2011). The Science and Applications of Synthetic and Systems Biology: Workshop Summary. Washington, DC, The National Academies Press.

Many potential applications of synthetic and systems biology are relevant to the challenges associated with the detection, surveillance, and responses to emerging and re-emerging infectious diseases. On March 14 and 15, 2011, the Institute of Medicine’s (IOM’s) Forum on Microbial Threats convened a public workshop in Washington, DC, to explore the current state of the science of synthetic biology, including its dependency on systems biology; discussed the different approaches that scientists are taking to engineer, or reengineer, biological systems; and discussed how the tools and approaches of synthetic and systems biology were being applied to mitigate the risks associated with emerging infectious diseases. The Science and Applications of Synthetic and Systems Biology is organized into sections as a topic-by-topic distillation of the presentations and discussions that took place at the workshop. Its purpose is to present information from relevant experience, to delineate a range of pivotal issues and their respective challenges, and to offer differing perspectives on the topic as discussed and described by the workshop participants. This report also includes a collection of individually authored papers and commentary.


 * Institute of Medicine (2012). Adverse Effects of Vaccines: Evidence and Causality. Washington, DC, The National Academies Press.

In 1900, for every 1,000 babies born in the United States, 100 would die before their first birthday, often due to infectious diseases. Today, vaccines exist for many viral and bacterial diseases. The National Childhood Vaccine Injury Act, passed in 1986, was intended to bolster vaccine research and development through the federal coordination of vaccine initiatives and to provide relief to vaccine manufacturers facing financial burdens. The legislation also intended to address concerns about the safety of vaccines by instituting a compensation program, setting up a passive surveillance system for vaccine adverse events, and by providing information to consumers. A key component of the legislation required the U.S. Department of Health and Human Services to collaborate with the Institute of Medicine to assess concerns about the safety of vaccines and potential adverse events, especially in children. Adverse Effects of Vaccines reviews the epidemiological, clinical, and biological evidence regarding adverse health events associated with specific vaccines covered by the National Vaccine Injury Compensation Program (VICP), including the varicella zoster vaccine, influenza vaccines, the hepatitis B vaccine, and the human papillomavirus vaccine, among others. For each possible adverse event, the report reviews peer-reviewed primary studies, summarizes their findings, and evaluates the epidemiological, clinical, and biological evidence. It finds that while no vaccine is 100 percent safe, very few adverse events are shown to be caused by vaccines. In addition, the evidence shows that vaccines do not cause several conditions. For example, the MMR vaccine is not associated with autism or childhood diabetes. Also, the DTaP vaccine is not associated with diabetes and the influenza vaccine given as a shot does not exacerbate asthma. Adverse Effects of Vaccines will be of special interest to the National Vaccine Program Office, the VICP, the Centers for Disease Control and Prevention, vaccine safety researchers and manufacturers, parents, caregivers, and health professionals in the private and public sectors.


 * Institute of Medicine (2012). Ensuring Safe Foods and Medical Products Through Stronger Regulatory Systems Abroad. Washington, DC, The National Academies Press.

A very high portion of the seafood we eat comes from abroad, mainly from China and Southeast Asia, and most of the active ingredients in medicines we take originate in other countries. Many low- and middle-income countries have lower labor costs and fewer and less stringent environmental regulations than the United States, making them attractive places to produce food and chemical ingredients for export. Safe Foods and Medical Products Through Stronger Regulatory Systems Abroad explains that the diversity and scale of imports makes it impractical for U.S. Food and Drug Administration (FDA) border inspections to be sufficient to ensure product purity and safety, and incidents such as American deaths due to adulterated heparin imported from China propelled the problem into public awareness. The Institute of Medicine Committee on Strengthening Core Elements of Regulatory Systems in Developing Countries took up the vital task of helping the FDA to cope with the reality that so much of the food, drugs, biologics, and medical products consumed in the United States originate in countries with less-robust regulatory systems. Ensuring Safe Foods and Medical Products Through Stronger Regulatory Systems Abroad describes the ways the United States can help strengthen regulatory systems in low and middle income countries and promote cross-border partnerships - including government, industry, and academia - to foster regulatory science and build a core of regulatory professionals. This report also emphasizes an array of practical approaches to ensure sound regulatory practices in today’s interconnected world.


 * Institute of Medicine (2012). Facilitating Collaborations to Develop Combination Investigational Cancer Therapies: Workshop Summary. Washington, DC, The National Academies Press.

Advances in biomedical research have increased our understanding of the complex nature of disease and the interaction of multiple molecular pathways involved in cancer. Combining investigational products early in their development is thought to be a promising strategy for identifying effective therapies. The IOM’s National Cancer Policy Forum held a workshop to discuss challenges and identify potential solutions to improve collaboration and advance the development of combination investigational cancer therapies.


 * Institute of Medicine (2012). Ranking Vaccines: A Prioritization Framework: Phase I: Demonstration of Concept and a Software Blueprint. Washington, DC, The National Academies Press.

As a number of diseases emerge or reemerge thus stimulating new vaccine development opportunities to help prevent those diseases, it can be especially difficult for decision makers to know where to invest their limited resources. Therefore, it is increasingly important for decision makers to have the tools that can assist and inform their vaccine prioritization efforts. In this first phase report, the IOM offers a framework and proof of concept to account for various factors influencing vaccine prioritization-demographic, economic, health, scientific, business, programmatic, social, policy factors and public concerns. Ranking Vaccines: A Prioritization Framework describes a decision-support model and the blueprint of a software-called Strategic Multi-Attribute Ranking Tool for Vaccines or SMART Vaccines. SMART Vaccines should be of help to decision makers. SMART Vaccines Beta is not available for public use, but SMART Vaccines 1.0 is expected to be released at the end of the second phase of this study, when it will be fully operational and capable of guiding discussions about prioritizing the development and introduction of new vaccines.


 * Institute of Medicine (2012). Strengthening a Workforce for Innovative Regulatory Science in Therapeutics Development: Workshop Summary. Washington, DC, The National Academies Press.

The development and application of regulatory science - which FDA has defined as the science of developing new tools, standards, and approaches to assess the safety, efficacy, quality, and performance of FDA-regulated products - calls for a well-trained, scientifically engaged, and motivated workforce. FDA faces challenges in retaining regulatory scientists and providing them with opportunities for professional development. In the private sector, advancement of innovative regulatory science in drug development has not always been clearly defined, well coordinated, or connected to the needs of the agency. As a follow-up to a 2010 workshop, the IOM held a workshop on September 20-21, 2011, to provide a format for establishing a specific agenda to implement the vision and principles relating to a regulatory science workforce and disciplinary infrastructure as discussed in the 2010 workshop.


 * Institute of Medicine (2013). The Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies. Washington, DC, The National Academies Press.

Vaccines are among the most safe and effective public health interventions to prevent serious disease and death. Because of the success of vaccines, most Americans today have no firsthand experience with such devastating illnesses as polio or diphtheria. Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advisory Committee on Immunization Practices. Under the current schedule, children younger than six may receive as many as 24 immunizations by their second birthday. New vaccines undergo rigorous testing prior to receiving FDA approval; however, like all medicines and medical interventions, vaccines carry some risk. Driven largely by concerns about potential side effects, there has been a shift in some parents’ attitudes toward the child immunization schedule. The Childhood Immunization Schedule and Safety identifies research approaches, methodologies, and study designs that could address questions about the safety of the current schedule. This report is the most comprehensive examination of the immunization schedule to date. The IOM authoring committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule. Should signals arise that there may be need for investigation, however, the report offers a framework for conducting safety research using existing or new data collection systems.


 * Institute of Medicine (2013). International Regulatory Harmonization Amid Globalization of Drug Development: Workshop Summary. Washington, DC, The National Academies Press.

The past several decades have been a time of rapid globalization in the development, manufacture, marketing, and distribution of medical products and technologies. Increasingly, research on the safety and effectiveness of new drugs is being conducted in countries with little experience in regulation of medical product development. Demand has been increasing for globally harmonized, science-based standards for the development and evaluation of the safety, quality, and efficacy of medical products. Consistency of such standards could improve the efficiency and clarity of the drug development and evaluation process and, ultimately, promote and enhance product quality and the public health. To explore the need and prospects for greater international regulatory harmonization for drug development, the IOM Forum on Drug Discovery, Development, and Translation hosted a workshop on February 13-14, 2013. Discussions at the workshop helped identify principles, potential approaches, and strategies to advance the development or evolution of more harmonized regulatory standards. This document summarizes the workshop.


 * Institute of Medicine (2013). Ranking Vaccines: A Prioritization Software Tool: Phase II: Prototype of a Decision-Support System. Washington, DC, The National Academies Press.

SMART Vaccines--Strategic Multi-Attribute Ranking Tool for Vaccines--is a prioritization software tool developed by the Institute of Medicine that utilizes decision science and modeling to help inform choices among candidates for new vaccine development. A blueprint for this computer-based guide was presented in the 2012 report Ranking Vaccines: A Prioritization Framework: Phase I. Ranking Vaccines: A Prioritization Software Tool, Phase II extends the proof-of-concept presented in the Phase I report, which was based on multi-attribute utility theory. This report refines a beta version of the model developed in the Phase I report and presents its next iteration, SMART Vaccines 1.0. Ranking Vaccines: Phase II discusses the methods underlying the development, validation, and evaluation of SMART Vaccines 1.0. It also discusses how SMART Vaccines should--and, just as importantly, should not--be used. The report also offers ideas for future enhancements for SMART Vaccines as well as for ideas for expanded uses and considerations and possibilities for the future.


 * Institute of Medicine (2015). Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC, The National Academies Press.

In the past half century, deadly disease outbreaks caused by novel viruses of animal origin - Nipah virus in Malaysia, Hendra virus in Australia, Hantavirus in the United States, Ebola virus in Africa, along with HIV (human immunodeficiency virus), several influenza subtypes, and the SARS (sudden acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronaviruses - have underscored the urgency of understanding factors influencing viral disease emergence and spread. Emerging Viral Diseases is the summary of a public workshop hosted in March 2014 to examine factors driving the appearance, establishment, and spread of emerging, re-emerging and novel viral diseases; the global health and economic impacts of recently emerging and novel viral diseases in humans; and the scientific and policy approaches to improving domestic and international capacity to detect and respond to global outbreaks of infectious disease. This report is a record of the presentations and discussion of the event.


 * Institute of Medicine and National Academies of Sciences Engineering and Medicine (2016). Global Health Risk Framework: Research and Development of Medical Products: Workshop Summary. Washington, DC, The National Academies Press.

Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Research and Development of Medical Products are summarized in this report.


 * Institute of Medicine and National Academy of Engineering (2015). Ranking Vaccines: Applications of a Prioritization Software Tool: Phase III: Use Case Studies and Data Framework. Washington, DC, The National Academies Press.

SMART Vaccines - Strategic Multi-Attribute Ranking Tool for Vaccines - is a prioritization software tool developed by the Institute of Medicine that utilizes decision science and modeling to help inform choices among candidates for new vaccine development. A blueprint for this computer-based guide was presented in the 2012 report Ranking Vaccines: A Prioritization Framework: Phase I. The 2013 Phase II report refined a beta version of the model developed in the Phase I report. Ranking Vaccines: Applications of a Prioritization Software Tool: Phase III: Use Case Studies and Data Framework extends this project by demonstrating the practical applications of SMART Vaccines through use case scenarios in partnership with the Public Health Agency of Canada, New York State Department of Health, and the Serum Institute of India. This report also explores a novel application of SMART Vaccines in determining new vaccine product profiles, and offers practical strategies for data synthesis and estimation to encourage the broader use of the software.


 * Institute of Medicine and National Research Council (2004). Giving Full Measure to Countermeasures: Addressing Problems in the DoD Program to Develop Medical Countermeasures Against Biological Warfare Agents. Washington, DC, The National Academies Press.

In recent years, substantial efforts have been initiated to develop new drugs, vaccines, and other medical interventions against biological agents that could be used in bioterrorist attacks against civilian populations. According to a new congressionally mandated report from the Institute of Medicine and National Research Council of the National Academies, to successfully develop these drugs, vaccines, and other medical interventions against biowarfare agents, Congress should authorize the creation of a new agency within the Office of the Secretary of the U.S. Department of Defense. The committee recommended that Congress should improve liability protections for those who develop and manufacture these products, to stimulate willingness to invest in new research and development for biowarfare protection. Giving Full Measure to Countermeasures also identifies other challenges—such as the need for appropriate animal models and laboratories equipped with high-level biosafety protections—that will require attention if DoD efforts to develop new medical countermeasures are to be successful.


 * Institute of Medicine and National Research Council (2005). An International Perspective on Advancing Technologies and Strategies for Managing Dual-Use Risks: Report of a Workshop. Washington, DC, The National Academies Press.
 * Institute of Medicine and National Research Council (2011). Chimpanzees in Biomedical and Behavioral Research: Assessing the Necessity. Washington, DC, The National Academies Press.

For many years, experiments using chimpanzees have been instrumental in advancing scientific knowledge and have led to new medicines to prevent life-threatening and debilitating diseases. However, recent advances in alternate research tools have rendered chimpanzees largely unnecessary as research subjects. The Institute of Medicine, in collaboration with the National Research Council, conducted an in-depth analysis of the scientific necessity for chimpanzees in NIH-funded biomedical and behavioral research. The committee concludes that while the chimpanzee has been a valuable animal model in the past, most current biomedical research use of chimpanzees is not necessary, though noted that it is impossible to predict whether research on emerging or new diseases may necessitate chimpanzees in the future.


 * Institute of Medicine and National Research Council (2013). Perspectives on Research with H5N1 Avian Influenza: Scientific Inquiry, Communication, Controversy: Summary of a Workshop. Washington, DC, The National Academies Press.

When, in late 2011, it became public knowledge that two research groups had submitted for publication manuscripts that reported on their work on mammalian transmissibility of a lethal H5N1 avian influenza strain, the information caused an international debate about the appropriateness and communication of the researchers’ work, the risks associated with the work, partial or complete censorship of scientific publications, and dual-use research of concern in general. Recognizing that the H5N1 research is only the most recent scientific activity subject to widespread attention due to safety and security concerns, on May 1, 2012, the National Research Council’s Committee on Science, Technology and Law, in conjunction with the Board on Life Sciences and the Institute of Medicine’s Forum on Microbial Threats, convened a one-day public workshop for the purposes of 1) discussing the H5N1 controversy; 2) considering responses by the National Institute of Allergy and Infectious Diseases (NIAID), which had funded this research, the World Health Organization, the U.S. National Science Advisory Board for Biosecurity (NSABB), scientific publishers, and members of the international research community; and 3) providing a forum wherein the concerns and interests of the broader community of stakeholders, including policy makers, biosafety and biosecurity experts, non-governmental organizations, international organizations, and the general public might be articulated. Perspectives on Research with H5N1 Avian Influenza: Scientific Enquiry, Communication, Controversy summarizes the proceedings of the workshop.


 * Institute of Medicine and National Research Council (2015). Potential Risks and Benefits of Gain-of-Function Research: Summary of a Workshop. Washington, DC, The National Academies Press.

On October 17, 2014, spurred by incidents at U.S. government laboratories that raised serious biosafety concerns, the United States government launched a one-year deliberative process to address the continuing controversy surrounding so-called “gain-of-function” (GOF) research on respiratory pathogens with pandemic potential. The gain of function controversy began in late 2011 with the question of whether to publish the results of two experiments involving H5N1 avian influenza and continued to focus on certain research with highly pathogenic avian influenza over the next three years. The heart of the U.S. process is an evaluation of the potential risks and benefits of certain types of GOF experiments with influenza, SARS, and MERS viruses that would inform the development and adoption of a new U.S. Government policy governing the funding and conduct of GOF research. Potential Risks and Benefits of Gain-of-Function Research is the summary of a two-day public symposia on GOF research. Convened in December 2014 by the Institute of Medicine and the National Research Council, the main focus of this event was to discuss principles important for, and key considerations in, the design of risk and benefit assessments of GOF research. Participants examined the underlying scientific and technical questions that are the source of current discussion and debate over GOF research involving pathogens with pandemic potential. This report is a record of the presentations and discussion of the meeting.


 * Medicine, I. o. (2003). An Assessment of the CDC Anthrax Vaccine Safety and Efficacy Research Program. Washington, DC, The National Academies Press.

In 1998, the Department of Defense (DoD) began a program of mandatory immunization against anthrax for all military personnel. As the program proceeded, however, some military personnel and their families raised concerns about the safety and efficacy of the anthrax vaccine. Acknowledging both the need to protect military personnel and the concerns about the anthrax vaccine, congress directed the Centers for Disease Control and Prevention (CDC) to carry out a research program on its safety and efficacy. To assist in the development of this program, CDC requested the Institute of Medicine (IOM) to convene a committee to review the completeness and appropriateness of the research program. In An Assessment of the CDC Anthrax Vaccine Safety and Efficacy Research Program, the committee makes an overall assessment of the CDD research plan and reviews the specific studies proposed by CDC in the three areas of efficacy, safety and acceptability. The committee also notes additional research needs that became evident following the bioterrorist events of 2001 and makes recommendations about the leadership of the research program.


 * Medicine, I. o. and N. R. Council (2003). Accelerating the Research, Development, and Acquisition of Medical Countermeasures Against Biological Warfare Agents: Interim Report. Washington, DC, The National Academies Press.
 * Medicine, I. o., et al. (2016). Rapid Medical Countermeasure Response to Infectious Diseases: Enabling Sustainable Capabilities Through Ongoing Public- and Private-Sector Partnerships: Workshop Summary. Washington, DC, The National Academies Press.

Emerging infectious disease threats that may not have available treatments or vaccines can directly affect the security of the world’s health since these diseases also know no boundaries and will easily cross borders. Sustaining public and private investment in the development of medical countermeasures (MCMs) before an emerging infectious disease becomes a public health emergency in the United States has been extremely challenging. Interest and momentum peak during a crisis and wane between events, and there is little interest in disease threats outside the United States until they impact people stateside. On March 26 and 27, 2015, the Institute of Medicine convened a workshop in Washington, DC to discuss how to achieve rapid and nimble MCM capability for new and emerging threats. Public- and private-sector stakeholders examined recent efforts to prepare for and respond to outbreaks of Ebola Virus Disease, pandemic influenza, and coronaviruses from policy, budget, and operational standpoints. Participants discussed the need for rapid access to MCM to ensure national security and considered strategies and business models that could enhance stakeholder interest and investment in sustainable response capabilities. This report summarizes the presentations and discussions from this workshop.


 * Medicine, N. A. o. S. E. a. (2017). Building Communication Capacity to Counter Infectious Disease Threats: Proceedings of a Workshop. Washington, DC, The National Academies Press.

Building communication capacity is a critical piece of preparing for, detecting, and responding to infectious disease threats. The International Health Regulations (IHR) establish risk communication—the real-time exchange of information, advice, and opinions between experts or officials and people who face a threat to their survival, health, and economic or social well-being—as a core capacity that World Health Organization member states must fulfill to strengthen the fight against these threats. Despite global recognition of the importance of complying with IHR, 67 percent of signatory countries report themselves as not compliant. By investing in communication capacity, public health and government officials and civil society organizations facing health crises would be prepared to provide advice, information, and reassurance to the public as well as to rapidly develop messages and community engagement activities that are coordinated and take into account social and behavioral dynamics among all sectors. To learn about current national and international efforts to develop the capacity to communicate effectively during times of infectious disease outbreaks, and to explore gaps in the research agenda that may help address communication needs to advance the field, the Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine convened a 1.5 day workshop on December 13 and 14, 2016, in Washington, DC. Participants reviewed progress and needs in strengthening communication capacity for dealing with infectious disease threats for both outbreaks and routine challenges in the United States and abroad. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2016). The Ebola Epidemic in West Africa: Proceedings of a Workshop. Washington, DC, The National Academies Press.

The most recent Ebola epidemic that began in late 2013 alerted the entire world to the gaps in infectious disease emergency preparedness and response. The regional outbreak that progressed to a significant public health emergency of international concern (PHEIC) in a matter of months killed 11,310 and infected more than 28,616. While this outbreak bears some unique distinctions to past outbreaks, many characteristics remain the same and contributed to tragic loss of human life and unnecessary expenditure of capital: insufficient knowledge of the disease, its reservoirs, and its transmission; delayed prevention efforts and treatment; poor control of the disease in hospital settings; and inadequate community and international responses. Recognizing the opportunity to learn from the countless lessons of this epidemic, the National Academies of Sciences, Engineering, and Medicine convened a workshop in March 2015 to discuss the challenges to successful outbreak responses at the scientific, clinical, and global health levels. Workshop participants explored the epidemic from multiple perspectives, identified important questions about Ebola that remained unanswered, and sought to apply this understanding to the broad challenges posed by Ebola and other emerging pathogens, to prevent the international community from being taken by surprise once again in the face of these threats. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2016). Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report. Washington, DC, The National Academies Press.

Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world’s hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the first of two, examines the feasibility of hepatitis B and C elimination in the United States and identifies critical success factors. The phase two report will outline a strategy for meeting the elimination goals discussed in this report.


 * National Academies of Sciences Engineering and Medicine (2016). Global Health Impacts of Vector-Borne Diseases: Workshop Summary. Washington, DC, The National Academies Press.

Pathogens transmitted among humans, animals, or plants by insects and arthropod vectors have been responsible for significant morbidity and mortality throughout recorded history. Such vector-borne diseases – including malaria, dengue, yellow fever, and plague – together accounted for more human disease and death in the 17th through early 20th centuries than all other causes combined. Over the past three decades, previously controlled vector-borne diseases have resurged or reemerged in new geographic locations, and several newly identified pathogens and vectors have triggered disease outbreaks in plants and animals, including humans. Domestic and international capabilities to detect, identify, and effectively respond to vector-borne diseases are limited. Few vaccines have been developed against vector-borne pathogens. At the same time, drug resistance has developed in vector-borne pathogens while their vectors are increasingly resistant to insecticide controls. Furthermore, the ranks of scientists trained to conduct research in key fields including medical entomology, vector ecology, and tropical medicine have dwindled, threatening prospects for addressing vector-borne diseases now and in the future. In June 2007, as these circumstances became alarmingly apparent, the Forum on Microbial Threats hosted a workshop to explore the dynamic relationships among host, pathogen(s), vector(s), and ecosystems that characterize vector-borne diseases. Revisiting this topic in September 2014, the Forum organized a workshop to examine trends and patterns in the incidence and prevalence of vector-borne diseases in an increasingly interconnected and ecologically disturbed world, as well as recent developments to meet these dynamic threats. Participants examined the emergence and global movement of vector-borne diseases, research priorities for understanding their biology and ecology, and global preparedness for and progress toward their prevention, control, and mitigation. This report summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2016). The Nation's Medical Countermeasure Stockpile: Opportunities to Improve the Efficiency, Effectiveness, and Sustainability of the CDC Strategic National Stockpile: Workshop Summary. Washington, DC, The National Academies Press.

Large catastrophic events, or rare acute events, may cause situations in which a local jurisdiction’s medicines and medical supplies are not sufficient to provide care to the population it serves. In these cases of natural or engineered disasters, such as a terrorist attack, influenza pandemic, or earthquake, state or local authorities can request that the federal government provide assets from the Strategic National Stockpile to augment the state and local jurisdictions’ resources. The Centers for Disease Control and Prevention’s (CDC’s) Strategic National Stockpile (SNS) is the nation’s repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel designed to supplement and resupply state and local public health agencies in the event of an emergency. The materiel is intended to support national health security and is managed by the Office of Public Health Preparedness and Response’s (OPHPR’s) Division of Strategic National Stockpile (DSNS). The stated mission of the SNS is to prepare and support partners and provide the right resources at the right time to secure the nation’s health. The National Academies of Sciences, Engineering, and Medicine organized a two-day public workshop to explore opportunities to improve the efficiency, effectiveness, and sustainable methods used by the CDC’s SNS to distribute medical countermeasures and other supplies during disasters and other public health emergencies, especially those which result in disruption of physical infrastructure such as the electrical grid, central roadways, bridges, and tunnels within the impacted community. Participants explored relevant distribution lessons learned from other federal agency stockpiles and the private sector as well as opportunities to develop public-private collaborations in the purchase, warehousing, management, and distribution of medical countermeasures. This report summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2016). Policy Issues in the Clinical Development and Use of Immunotherapy for Cancer Treatment: Proceedings of a Workshop. Washington, DC, The National Academies Press.

Immunotherapy is a form of cancer therapy that harnesses the body’s immune system to destroy cancer cells. In recent years, immunotherapies have been developed for several cancers, including advanced melanoma, lung cancer, and kidney cancer. In some patients with metastatic cancers who have not responded well to other treatments, immunotherapy treatment has resulted in complete and durable responses. Given these promising findings, it is hoped that continued immunotherapy research and development will produce better cancer treatments that improve patient outcomes. With this promise, however, there is also recognition that the clinical and biological landscape for immunotherapies is novel and not yet well understood. For example, adverse events with immunotherapy treatment are quite different from those experienced with other types of cancer therapy. Similarly, immunotherapy dosing, therapeutic responses, and response time lines are also markedly different from other cancer therapies. To examine these challenges and explore strategies to overcome them, the National Academies of Sciences, Engineering, and Medicine held a workshop in February and March of 2016. This report summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2017). Building a National Capability to Monitor and Assess Medical Countermeasure Use During a Public Health Emergency: Going Beyond the Last Mile: Proceedings of a Workshop. Washington, DC, The National Academies Press.

During public health emergencies (PHEs) involving chemical, biological, radiological, or nuclear threats or emerging infectious diseases, medical countermeasures (MCMs) (e.g., drugs, vaccines, devices) may need to be dispensed or administered to affected populations to help mitigate the human health impact of the threat. The optimal MCMs determined for use during an emergency might be U.S. Food and Drug Administration (FDA) approved but used in unapproved ways (e.g., in a new age group or against a new agent); FDA approved using animal models because human efficacy testing is not ethical or feasible; or not yet FDA approved for any indication. As part of the United States’ scientific and research preparedness enterprise, there is an imperative to go “beyond the last mile” of MCM dispensing and administration to build and maintain a national capability to monitor and assess the use of MCMs (e.g., safety, compliance, clinical benefit) after they have been dispensed during PHEs. To further the discussion on this need, the Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine hosted a 2-day public workshop, Building a National Capability to Monitor and Assess Medical Countermeasure Use in Response to Public Health Emergencies. The workshop, sponsored by FDA, was held on June 6–7, 2017, in Washington, DC. Workshop participants discussed the roles and efforts of the federal government and of relevant stakeholders with an interest in building and maintaining a national PHE MCM active monitoring and assessment capability. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2017). Combating Antimicrobial Resistance: A One Health Approach to a Global Threat: Proceedings of a Workshop. Washington, DC, The National Academies Press.

As of 2017, the emergence and spread of antimicrobial resistance continues unabated around the world, leaving devastating health and economic outcomes in its wake. Those consequences will multiply if collaborative global action is not taken to address the spread of resistance. Major drivers of antimicrobial resistance in humans have been accelerated by inappropriate antimicrobial prescribing in health care practices; the inappropriate use of antimicrobials in livestock; and the promulgation of antibiotic resistance genes in the environment. To explore the issue of antimicrobial resistance, the Forum of Microbial Threats planned a public workshop. Participants explored issues of antimicrobial resistance through the lens of One Health, which is a collaborative approach of multiple disciplines - working locally, nationally, and globally - for strengthening systems to counter infectious diseases and related issues that threaten human, animal, and environmental health, with an end point of improving global health and achieving gains in development. They also discussed immediate and short-term actions and research needs that will have the greatest effect on reducing antimicrobial resistance, while taking into account the complexities of bridging different sectors and disciplines to address this global threat. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2017). Examining the Mistrust of Science: Proceedings of a Workshop–in Brief. Washington, DC, The National Academies Press.

The Government-University-Industry Research Roundtable held a meeting on February 28 and March 1, 2017, to explore trends in public opinion of science, examine potential sources of mistrust, and consider ways that cross-sector collaboration between government, universities, and industry may improve public trust in science and scientific institutions in the future. This publication briefly summarizes the presentations and discussions from the meeting.


 * National Academies of Sciences Engineering and Medicine (2017). Global Health and the Future Role of the United States. Washington, DC, The National Academies Press.

While much progress has been made on achieving the Millenium Development Goals over the last decade, the number and complexity of global health challenges has persisted. Growing forces for globalization have increased the interconnectedness of the world and our interdependency on other countries, economies, and cultures. Monumental growth in international travel and trade have brought improved access to goods and services for many, but also carry ongoing and ever-present threats of zoonotic spillover and infectious disease outbreaks that threaten all. Global Health and the Future Role of the United States identifies global health priorities in light of current and emerging world threats. This report assesses the current global health landscape and how challenges, actions, and players have evolved over the last decade across a wide range of issues, and provides recommendations on how to increase responsiveness, coordination, and efficiency – both within the U.S. government and across the global health field.


 * National Academies of Sciences Engineering and Medicine (2017). Integrating Clinical Research into Epidemic Response: The Ebola Experience. Washington, DC, The National Academies Press.

The 2014–2015 Ebola epidemic in western Africa was the longest and most deadly Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. The Ebola virus has been known since 1976, when two separate outbreaks were identified in the Democratic Republic of Congo (then Zaire) and South Sudan (then Sudan). However, because all Ebola outbreaks prior to that in West Africa in 2014–2015 were relatively isolated and of short duration, little was known about how to best manage patients to improve survival, and there were no approved therapeutics or vaccines. When the World Heath Organization declared the 2014-2015 epidemic a public health emergency of international concern in August 2014, several teams began conducting formal clinical trials in the Ebola affected countries during the outbreak. Integrating Clinical Research into Epidemic Response: The Ebola Experience assesses the value of the clinical trials held during the 2014–2015 epidemic and makes recommendations about how the conduct of trials could be improved in the context of a future international emerging or re-emerging infectious disease events.


 * National Academies of Sciences Engineering and Medicine (2017). A National Strategy for the Elimination of Hepatitis B and C: Phase Two Report. Washington, DC, The National Academies Press.

Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world’s hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the second of two, builds off the conclusions of the first report and outlines a strategy for hepatitis reduction over time and specific actions to achieve them.


 * National Academies of Sciences Engineering and Medicine (2018). Impact of the Global Medical Supply Chain on SNS Operations and Communications: Proceedings of a Workshop. Washington, DC, The National Academies Press.

The Centers for Disease Control and Prevention (CDC) established the Strategic National Stockpile (SNS) with a focus on procuring and managing medical countermeasures (MCM) designed to address chemical, biological, radiological, and nuclear events and attacks by weapons of mass destruction. The stockpile is a repository of antibiotics, chemical antidotes, antitoxins, vaccines, antiviral drugs, and other medical materiel organized to respond to a spectrum of public health threats. Over time, the mission of the SNS has informally evolved to address other large-scale catastrophes, such as hurricanes or outbreaks of pandemic disease, and rare acute events, such as earthquakes or terror attacks. When disaster strikes, states can request deployment of SNS assets to augment resources available to state, local, tribal, or territorial public health agencies. CDC works with federal, state, and local health officials to identify and address their specific needs and, according to the stated mission of the SNS, ensure that the right resources reach the right place at the right time. On August 28, 2017, the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the current state of the global medical supply chain as it relates to SNS assets, and the role of communications in mitigating supply chain risks and in enhancing the resilience of MCM distribution efforts. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2018). Review of Report and Approach to Evaluating Long-Term Health Effects in Army Test Subjects. Washington, DC, The National Academies Press.

Between 1942 and 1975, the U.S. Army conducted tests on human subjects to study the effects of a variety of agents, including chemical warfare agents, biological agents, medications, vaccines, and other substances. The tests investigated the immediate or short-term health effects from acute exposure to understand vulnerabilities to attack. Whether the exposures could have resulted in long-term health consequences to the test subjects has been assessed periodically, and the Army is required to notify subjects of information relating to potential health effects associated with exposure to the test agents. Most recently, a 2016 court injunction directed the Army to provide test subjects with new information about potential long-term health effects associated with their exposures, and to provide medical care if an injury or illness could be attributed to their participation in an Army chemical or biological testing program. In support of the first requirement, the Army contracted a report, Assessment of Potential Long-Term Health Effects on Army Human Test Subjects of Relevant Biological and Chemical Agents, Drugs, Medications and Substances: Literature Review and Analysis (the Report), to determine whether new information published since 2006 should be provided to the veterans. At the request of the Army, the National Academies of Sciences, Engineering, and Medicine formed an ad hoc committee that was tasked with conducting an independent review of the Report. The committee assessed whether the Report appropriately identified potential long-term health effects that could have resulted from test exposures using an adequate weight-of-evidence approach. The general approach for evaluating agent- and outcome-specific associations as outlined in the Army Memorandum was also reviewed. An interim report of its overarching findings and their supporting evidence was prepared in February 2018. This final report provides additional detail about the basis of the committee’s findings and recommendations. No new findings or recommendations have been added to this report.


 * National Academies of Sciences Engineering and Medicine (2019). Continuous Manufacturing for the Modernization of Pharmaceutical Production: Proceedings of a Workshop. Washington, DC, The National Academies Press.

On July 30-31, 2018, the National Academies of Sciences, Engineering, and Medicine held a workshop titled Continuous Manufacturing for the Modernization of Pharmaceutical Production. This workshop discussed the business and regulatory concerns associated with adopting continuous manufacturing techniques to produce biologics such as enzymes, monoclonal antibodies, and vaccines. The participants also discussed specific challenges for integration across the manufacturing system, including upstream and downstream processes, analytical techniques, and drug product development. The workshop addressed these challenges broadly across the biologics domain but focused particularly on drug categories of greatest FDA and industrial interest such as monoclonal antibodies and vaccines. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2019). Exploring Lessons Learned from a Century of Outbreaks: Readiness for 2030: Proceedings of a Workshop. Washington, DC, The National Academies Press.

In November 2018, an ad hoc planning committee at the National Academies of Sciences, Engineering, and Medicine planned two sister workshops held in Washington, DC, to examine the lessons from influenza pandemics and other major outbreaks, understand the extent to which the lessons have been learned, and discuss how they could be applied further to ensure that countries are sufficiently ready for future pandemics. This publication summarizes the presentations and discussions from both workshops.


 * National Academies of Sciences Engineering and Medicine (2020). Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC, The National Academies Press.

On December 4–5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop.


 * National Academies of Sciences Engineering and Medicine (2020). Genomic Epidemiology Data Infrastructure Needs for SARS-CoV-2: Modernizing Pandemic Response Strategies. Washington, DC, The National Academies Press.

In December 2019, new cases of severe pneumonia were first detected in Wuhan, China, and the cause was determined to be a novel beta coronavirus related to the severe acute respiratory syndrome (SARS) coronavirus that emerged from a bat reservoir in 2002. Within six months, this new virus—SARS coronavirus 2 (SARS-CoV-2)—has spread worldwide, infecting at least 10 million people with an estimated 500,000 deaths. COVID-19, the disease caused by SARS-CoV-2, was declared a public health emergency of international concern on January 30, 2020 by the World Health Organization (WHO) and a pandemic on March 11, 2020. To date, there is no approved effective treatment or vaccine for COVID-19, and it continues to spread in many countries. Genomic Epidemiology Data Infrastructure Needs for SARS-CoV-2: Modernizing Pandemic Response Strategies lays out a framework to define and describe the data needs for a system to track and correlate viral genome sequences with clinical and epidemiological data. Such a system would help ensure the integration of data on viral evolution with detection, diagnostic, and countermeasure efforts. This report also explores data collection mechanisms to ensure a representative global sample set of all relevant extant sequences and considers challenges and opportunities for coordination across existing domestic, global, and regional data sources.


 * National Academy of Sciences and National Research Council (2012). Biosecurity Challenges of the Global Expansion of High-Containment Biological Laboratories: Summary of a Workshop. Washington, DC, The National Academies Press.

During July 10-13, 2011, 68 participants from 32 countries gathered in Istanbul, Turkey for a workshop organized by the United States National Research Council on Anticipating Biosecurity Challenges of the Global Expansion of High-containment Biological Laboratories. The United States Department of State’s Biosecurity Engagement Program sponsored the workshop, which was held in partnership with the Turkish Academy of Sciences. The international workshop examined biosafety and biosecurity issues related to the design, construction, maintenance, and operation of high-containment biological laboratories- equivalent to United States Centers for Disease Control and Prevention biological safety level 3 or 4 labs. Although these laboratories are needed to characterize highly dangerous human and animal pathogens, assist in disease surveillance, and produce vaccines, they are complex systems with inherent risks. Biosecurity Challenges of the Global Expansion of High-Containment Biological Laboratories summarizes the workshop discussion, which included the following topics: Technological options to meet diagnostic, research, and other goals; Laboratory construction and commissioning; Operational maintenance to provide sustainable capabilities, safety, and security; and Measures for encouraging a culture of responsible conduct. Workshop attendees described the history and current challenges they face in their individual laboratories. Speakers recounted steps they were taking to improve safety and security, from running training programs to implementing a variety of personnel reliability measures. Many also spoke about physical security, access controls, and monitoring pathogen inventories. Workshop participants also identified tensions in the field and suggested possible areas for action.


 * National Research Council (2001). Opportunities in Biotechnology for Future Army Applications. Washington, DC, The National Academies Press.

This report surveys opportunities for future Army applications in biotechnology, including sensors, electronics and computers, materials, logistics, and medical therapeutics, by matching commercial trends and developments with enduring Army requirements. Several biotechnology areas are identified as important for the Army to exploit, either by direct funding of research or by indirect influence of commercial sources, to achieve significant gains in combat effectiveness before 2025.


 * National Research Council (2005). Partnering Against Terrorism: Summary of a Workshop. Washington, DC, The National Academies Press.

This book summarizes a major conference organized to bring the lessons of the Academy’s unprecedented analysis of Government-Industry Partnerships to bear on the war on terror. By encouraging policy attention to examples of effective partnerships (in particular, the need for clear goals and regular assessments), this book contributes to a better understanding of the potential of partnerships to bring new security-enhancing technologies and equipment to the market in a cost-effective and timely manner. Partnerships often involve innovation awards which act as a catalyst for small firms or for cooperation among large and small firms and universities to work together on innovative new technologies which are able to address the special challenge of global terrorism. The public–private cooperation reviewed in the conference has the potential to make government funding for security more effective, by leveraging the ingenuity of the private sector to meet the critical national mission of protecting our citizens from terrorism.


 * National Research Council (2006). The Genomic Revolution: Implications for Treatment and Control of Infectious Disease: Working Group Summaries. Washington, DC, The National Academies Press.

The 2005 conference, “The Genomic Revolution: Implications for Treatment and Control of Infectious Disease,” attracted scientists, engineers, and medical researchers to work on new interdisciplinary responses using genomics to treat and control infectious diseases. Eleven conference working groups gave the participants eight hours to develop new research approaches to problems in infectious disease using genomics. Among the challenges were designing a new device to detect viral and bacterial pathogens; how best to use $100 million to prevent a future pandemic flu outbreak; how to improve rapid response to an outbreak of disease and reduce the cost of diagnostic tests; and how to sequence an individual’s genome for under $1,000. Representatives from public and private funding organizations, government, industry, and the science media also participated in the working groups. This book provides a summary of the conference working groups. For more information about the conference, visit www.keckfutures.org/genomics. The National Academies Keck Futures Initiative was launched in 2003 to stimulate new modes of scientific inquiry and break down the conceptual and institutional barriers to interdisciplinary research. The National Academies and the W.M. Keck Foundation believe considerable scientific progress and social benefit will be achieved by providing a counterbalance to the tendency to isolate research within academic fields. The Futures Initiative is designed to enable researchers from different disciplines to focus on new questions upon which they can base entirely new research, and to encourage better communication between scientists as well as between the scientific community and the public. Funded by a $40 million grant from the W.M. Keck Foundation, the National Academies Keck Futures Initiative is a 15-year effort to catalyze interdisciplinary inquiry and to enhance communication among researchers, funding agencies, universities, and the general public with the object of stimulating interdisciplinary research at the most exciting frontiers. The Futures Initiative builds on three pillars of vital and sustained research: interdisciplinary encounters that counterbalance specialization and isolation; the identification and exploration of new research topics; and communication that bridges languages, cultures, habits of thought, and institutions. Toward these goals, the National Academies Keck Futures Initiative incorporates three core activities each year: Futures conferences, Futures grants, and National Academies Communication Awards.


 * National Research Council (2006). Treating Infectious Diseases in a Microbial World: Report of Two Workshops on Novel Antimicrobial Therapeutics. Washington, DC, The National Academies Press.

Humans coexist with millions of harmless microorganisms, but emerging diseases, resistance to antibiotics, and the threat of bioterrorism are forcing scientists to look for new ways to confront the microbes that do pose a danger. This report identifies innovative approaches to the development of antimicrobial drugs and vaccines based on a greater understanding of how the human immune system interacts with both good and bad microbes. The report concludes that the development of a single superdrug to fight all infectious agents is unrealistic.


 * National Research Council (2007). Citizen Engagement in Emergency Planning for a Flu Pandemic: A Summary of the October 23, 2006 Workshop of the Disasters Roundtable. Washington, DC, The National Academies Press.
 * National Research Council (2010). Considerations for Ensuring Safety and Efficacy of Vaccines and Therapeutic Proteins Manufactured by Using Platform Approaches: Summary of a Workshop. Washington, DC, The National Academies Press.

A major goal of the US Department of Defense (DOD) Transformational Medical Technologies Initiative (TMTI) is to develop countermeasures that will protect military personnel against bioweapons, including specific infectious-disease agents and toxins. An explicit TMTI objective is to respond quickly to such threats by producing an appropriate amount of an effective countermeasure--currently defined as enough material to treat or vaccinate 3 million personnel--within 12 months of identification of a specific threat. DOD officials call for TMTI programs to be up and running by 2014. The National Academies hosted a workshop which brought together scientists from academe, government, and the biotechnology industry to identify and discuss challenges and ideas related to the TMTI’s vision of developing countermeasures within a few months after an agent is identified. The workshop focused on manufacturing processes and specifically on the development of “manufacturing platforms”--repeatable components of manufacturing that reduce both development time and risk. An underlying assumption was that demonstrating that integrated platforms can reliably produce safe and efficacious countermeasures might shorten the regulatory approval process. The workshop is summarized in this book.


 * National Research Council (2011). Animal Models for Assessing Countermeasures to Bioterrorism Agents. Washington, DC, The National Academies Press.

The Transformational Medical Technologies (TMT) has been a unique component of the U.S. Department of Defense (DoD) medical biodefense efforts since 2006. Its mission is to advance countermeasure research and development in support of the broader goal of the DoD to protect warfighters from emerging infectious diseases and future genetically engineered biological weapons. The TMT, using advanced science and technology approaches, focused on the development of roadspectrum countermeasures that target common host and pathogen pathways or enhance the host’s immune response. Many of these pathogens are lethal or cause such debilitating diseases in humans that it is ethically inappropriate to test the efficacy of these countermeasures in human volunteers. In lieu of human participants, these products may be tested in animals and approved for human use under the provisions of the Food and Drug Administration (FDA)’s 2002 Animal Rule. The reliance on animal models for the development and licensure of medical countermeasures against biothreats is challenging for a number of reasons. The ad hoc Committee on Animal Models for Assessing Countermeasures to Bioterrorism Agents prepared a consensus report that would address the challenges stemming from developing and testing medical countermeasures against biothreat agents in animal models. Animal Models for Assessing Countermeasures to Bioterrorism Agents evaluates how well the existing TMT-employed or candidate animal models reflect the pathophysiology, clinical picture, and treatment of human disease as related to the agents of interest. The report addresses the process and/or feasibility of developing new animal models for critical biodefense research, placing emphasis on the need for a robust and expeditious validation process in terms of the FDA’s Animal Rule. The report also evaluates alternatives to the use of animal models based on the premise of the Three Rs.


 * National Research Council (2011). Life Sciences and Related Fields: Trends Relevant to the Biological Weapons Convention. Washington, DC, The National Academies Press.

During the last decade, national and international scientific organizations have become increasingly engaged in considering how to respond to the biosecurity implications of developments in the life sciences and in assessing trends in science and technology (S&amp;T) relevant to biological and chemical weapons nonproliferation. The latest example is an international workshop, Trends in Science and Technology Relevant to the Biological Weapons Convention, held October 31 - November 3, 2010 at the Institute of Biophysics of the Chinese Academy of Sciences in Beijing. Life Sciences and Related Fields summarizes the workshop, plenary, and breakout discussion sessions held during this convention. Given the immense diversity of current research and development, the report is only able to provide an overview of the areas of science and technology the committee believes are potentially relevant to the future of the Biological and Toxic Weapons Convention (BWC), although there is an effort to identify areas that seemed particularly ripe for further exploration and analysis. The report offers findings and conclusions organized around three fundamental and frequently cited trends in S&amp;T that affect the scope and operation of the convention: The rapid pace of change in the life sciences and related fields; The increasing diffusion of life sciences research capacity and its applications, both internationally and beyond traditional research institutions; and The extent to which additional scientific and technical disciplines beyond biology are increasingly involved in life sciences research. The report does not make recommendations about policy options to respond to the implications of the identified trends. The choice of such responses rests with the 164 States Parties to the Convention, who must take into account multiple factors beyond the project’s focus on the state of the science.


 * National Research Council (2011). Protecting the Frontline in Biodefense Research: The Special Immunizations Program. Washington, DC, The National Academies Press.

The U.S. Army’s Special Immunizations Program is an important component of an overall biosafety program for laboratory workers at risk of exposure to hazardous pathogens. The program provides immunizations to scientists, laboratory technicians and other support staff who work with certain hazardous pathogens and toxins. Although first established to serve military personnel, the program was expanded through a cost-sharing agreement in 2004 to include other government and civilian workers, reflecting the expansion in biodefense research in recent years. Protecting the Frontline in Biodefense Research examines issues related to the expansion of the Special Immunizations Program, considering the regulatory frameworks under which the vaccines are administered, how additional vaccines might be considered for inclusion in the Program, and factors that might influence the development and manufacturing of vaccines for the Special Immunizations Program.


 * National Research Council and Institute of Medicine (2011). A Risk-Characterization Framework for Decision-Making at the Food and Drug Administration. Washington, DC, The National Academies Press.

With the responsibility to ensure the safety of food, drugs, and other products, the U.S. Food and Drug Administration (FDA) faces decisions that may have public-health consequences every day. Often the decisions must be made quickly and on the basis of incomplete information. FDA recognized that collecting and evaluating information on the risks posed by the regulated products in a systematic manner would aid in its decision-making process. Consequently, FDA and the Department of Health and Human Services (DHHS) asked the National Research Council (NRC) to develop a conceptual model that could evaluate products or product categories that FDA regulates and provide information on the potential health consequences associated with them. A Risk-Characterization Framework for Decision-Making at the Food and Drug Administration describes the proposed risk-characterization framework that can be used to evaluate, compare, and communicate the public-health consequences of decisions concerning a wide variety of products. The framework presented in this report is intended to complement other risk-based approaches that are in use and under development at FDA, not replace them. It provides a common language for describing potential public-health consequences of decisions, is designed to have wide applicability among all FDA centers, and draws extensively on the well-vetted risk literature to define the relevant health dimensions for decision-making at the FDA. The report illustrates the use of that framework with several case studies, and provides conclusions and recommendations.