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APPENDIX B Workshop Agenda The Consequences of Viral Disease Eradication: Addressing Post-Immunization Challenges February 1-2, 2001 Lecture Room National Academy of Sciences 2101 Constitution Avenue, N.W., Washington, DC Thursday, February 1, 2001 8:30 Continental Breakfast 9:00 Welcome and workshop introduction Joshua Lederberg, Ph.D. Chair, Forum on Emerging Infections Sackler Founclation Scholar and Nobel Laureate The Rockefeller University, New York, NY Keynote address History and Prospects for Disease Eradication Ciro de Quadros, M.D., M.P.H. Director, Division of Vaccines and Immunization Pan American Health Organization, Washington, DC Session I: Case Studies of Major Eradication or Elimination Efforts This session will address the standards and strategies, technical feasibil- ity, political will, and financial commitment for several diseases targeted for eradication or elimination. Discussions will identify the successes and fail- ures of these efforts, and the challenges for post-eradication/elimination strategies. 183

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184 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION 10:00 Smallpox Donald A. Henderson, M.D., M.P.H. Director, Center for Civilian Biodefense Studies The Johns Hopkins University, Baltimore, MD 10:30 Break 10:45 The next target after polio: Global eradication of measles Stephen Cochi, M.D., M.P.H. Director, Vaccine-Preventable Disease Eradication Division National Immunization Program, Centers for Disease Control and Prevention, Atlanta GA 11:15 Eradication of congenital rubella syndrome Stanley A. Plotkin, M.D. Aventis Pasteur, Swiftwater, PA 11:45 Post-polio eradication: Issues and challenges Walter R. Dowdie, M.D. Public Health Consultant Task Force for Child Survival and Development, Atlanta, GA 12:15 Lunch Session II: Biologic Challenges to Post-Eradication This session will address the science-based underpinnings of how and when to stop immunization, and the protective actions that remain to be established. We will examine the current state-of-the-science of several dis- eases poised for elimination/eradication and identify gaps in our knowI- edge, primarily focusing on the risk of pathogen transmission to and main- tenance in susceptible individuals. Through the issues discussed we will identify the effect they have on the duration of disease elimination/eradica- tion programs, as well as the likelihood for their success. 1:30 Duration of infection, recrudescence, and environmental stability of pathogens targeted for elimination Professor Roy Anderson Chair, Department of Infectious Disease Epiclemiology Imperial College School of Medicine, London, UK

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APPENDIX B 2:15 2.45 Break 185 Laboratory specimens, genetic research, big-engineering, and the danger of malice C.~. Peters, M.D. Professor, Departments of Pathology, and Microbiology and Immunology Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX 3:00 Natural SIV reservoirs and human zoonotic risk Beatrice H. Hahn, M.D. Professor, Departments of Medicine and Microbiology University of Alabama, Birmingham, AL 3:30 Vaccine-associated cases Jeffrey I. Cohen, M.D Head, Medical Virology Section, Laboratory of Clinical Investigation National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD Adjourn public session Friday, February 2, 2001 Continental Breakfast 8:00 Opening remarks loshua Lederberg, Ph.D. Chair, Forum on Emerging Infections Session m Challenges to Post-Eradication Operational and Institutional Remediation The need for resources will likely increase for countries with multiple eradication campaigns, particularly as disease prevalence decreases and surveillance intensifies. This session will address the thoroughness with which public health systems and laboratories are able to define their limita- tions and manage their resources.

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186 8:15 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION International health regulations and quarantine Mario Libel, M.D. Division of Disease Prevention and Control Pan American Health Organization, Washington, DC 9:00 Disease surveillance, program management, and sustainability of . ~ immunization programs Donald S. Burke, M.D. Professor and Director, Center for Immunization Research, Department of International Health School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD The capacity of public health services to respond to an outbreak in the post-eradication era Car! E. Taylor, M.D., M.P.H. Professor Emeritus, Department of International Health School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD Laboratory security and regulations governing viral . . . . . . pat ~ogenesls in a post-lmmumzatlon era Raymond H. Cypess, D.V.M., Ph.D. President and CEO American Type Culture Collection (ATCC), Manassas, VA Frank Simione, M.S. American Type Culture Collection (ATCC), Manassas, VA 10:30 Break Session IV: Medical Intervention and Technological Solutions Many of the vaccines and drugs available today are the same ones that have been used for decades. This session will review the present vaccine and drug armamentaria with a view toward improving their safety, efficacy and potential value against diseases targeted for eradication.

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APPENDIX B 10:45 The polio eradication effort: should vaccine eradication be next; Vincent R. Racaniello, Ph.D. Higgins Professor, Department of Microbiology, and Editor, Journal of Virology Columbia University College of Physicians & Surgeons, New York, NY 11:15 Antiviral therapy in the management of post-eradication outbreaks Richard J. Whitley, M.D. Professor, Department of Pediatrics Ambulatory Care Center, School of Medicine, University of Alabama, South Birmingham, AL 11:45 Passive antibody and immune-enhancement strategies Diane E. Griffin, M.D., Ph.D. Professor and Chair, Department of Molecular Microbiology and Immunology School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 12:15 The potential role of probiotics and microbial ecology in host defense Susanna Cunningham-Rundles, Ph.D. Professor of Immunology Weill Medical College of Cornell University, New York, NY 12:45 Lunch :p 187 Session V: The Response to Post-Eradication Outbreaks Protecting populations that are no longer immune presents formidable challenges to public health agencies, pharmaceutical manufacturers, secu- rity analysts, and the public. Resolution of these issues in advance affects when and how prevention activities can be stopped in conjunction with disease eradication. d

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188 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION Preparedness of the U.S. health care system to respond to disease outbreaks Ken Bloem, M.D. Senior Fellow, The Johns Hopkins Center for Civilian Biodefense Studies Former CEO, Georgetown Medical Center 2:00 Vaccines for post-elimination (eradications contingencies Thomas Monath, M.D. Vice President, Research and Medical Affairs Acambis Inc. (formerly OraVax, Inc.), Cambridge, MA 2:30 3:00 Strategic priorities for addressing post-eradication outbreaks Robert Kadlec, M.D., M.T.M.H. Colonel, US Air Force, and Professor, Military Strategy and Operations National War College, National Defense University, Washington, D.C. Understanding the public and media response to an outbreak Ann E. Norwood, M.D. Colonel, US Army, Associate Professor and Associate Chair Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 3:30 Me post-eradication research agenda Joshua Lederberg, Ph.D. Chair, Forum on Emerging Infections Sackler Foundation Scholar, and Nobel Laureate The Rockefeller University, New York, NY 4:00 Break Session VI: Panel Session: Identifying the Tllreats and Mitigating the Impact The challenges and opportunities facing disease eradication and how they will affect public policy will be identified through an open discussion among invited panelists, Forum members, speakers, and the workshop au- dience. Issues to address will include the identification of possible require- ments that need to be met prior to eradication, such as collections of diverse isolates and strains, an organism's complete genomic sequence, full under- standing of the life history of the organism and its mechanisms of patho-

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APPENDIX B 189 genesis, legal issues and authorities surrounding the response to an epi- demic; and the ethical considerations pertaining to cessation of immuniza- tion, as well as preserving biodiversity versus species extinction. Co-Moderators: Invited Panelists: Joshua Lecterberg, Ph.D. Chair, Forum on Emerging Infections Margaret Hamburg, M.D., Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services Gail Cassell, Vice President, Infectious Diseases, Drug Discovery Research and Clinical Investigation, Eli Lilly & Company, Indianapolis, IN Michael Osterholm, Chairman and CEO, Infection Control Advisory Network, Inc., Eden Prairie, MN Stephen Teret AD, Professor, Program on Law and Public Health, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD Samuel L. Katz, M.D., D.Sc., Chairman of the Board, Burroughs WelIcome Fund, and; Wilburt C. Davison Professor & Chairman Emeritus, Department of Pediatrics, Duke University Medical Center, Durham, NC Ellyn W. Ogden, MPH, Worldwide Polio Eradication Coordinator and Senior Technical Advisor in Health and Child Survival, Bureau for Global Programs, U.S. Agency for International Development, Washington, D.C. 4:15 Pane! discussion, perspectives prom different communities, and synthesis Closing remarks Joshua Lederberg, Ph.D. Chair, Forum on Emerging Infections Sackler Foundation Scholar, and Nobel Laureate The Rockefeller University, New York, NY Adjournment