Thought Leadership

HPAI A(H5N1) Transmission Among Dairy Cattle in the U.S.: New Findings and Safety Measures

While the risk to the public remains low, the highly pathogenic avian influenza (HPAI) A(H5N1) is on the radar of those in sectors like livestock breeding, animal sciences and food production.

Published May 28, 2024

By Syra Madad, DHSc; Jason Kindrachuk, PhD; and Rick A. Bright, PhD

*Image courtesy of USDA NRCS Montana/Flickr*

Recent observations on highly pathogenic avian influenza (HPAI) A(H5N1) have highlighted the virus’s transmission among dairy cattle in the United States. Key findings include ongoing detection and transmission of H5N1 among cattle, a second human case of H5N1 infection in a farmworker; mixed virus receptor distribution in mammary gland tissue of cattle, genetic evolution of H5N1 with onward transmission, evaluation of pasteurization effectiveness for virus inactivation, and a clinical description of HPAI H5N1 influenza A virus infection in a U.S. dairy farm worker.

Genomic and Epidemiologic Insights

In May 2024, investigators at the U.S. Department of Agriculture (USDA) reported genomic and epidemiologic data showing HPAI A(H5N1) spillover to, and transmission among, cattle. While prior data on Influenza A virus in cattle is scarce, the current geographic expansion of HPAI H5N1 among herds across multiple U.S. states demonstrates clade 2.3.4.4b’s affinity for cattle.

Reduced food intake, milk production, and shifting milk quality was first noted in January 2024, followed by detection of influenza A virus, specifically H5N1 clade 2.3.4.4b genotype B3.13, by the National Animal Health Laboratory Network and National Veterinary Services Laboratories. Subsequent analysis suggested movement of genotype B3.13 between dairy cattle farms and domestic poultry.

The study’s authors suggested a single spillover event from wild birds with limited cattle-to-cattle transmission around December 2023. Additional spillovers were identified from infected cattle to poultry and other nearby mammals, with the virus potentially shedding from infected cattle for 14-21 days. Genome sequencing indicated ongoing evolution, possibly linked to mammalian adaptation.

Viral Receptor Distribution

Sialic acid receptors utilized by influenza A viruses for cellular attachment, are found in multiple cattle tissues, including the respiratory tract, mammary glands, and brain. Though all type of sialic acid receptors could be found in each of these areas, the types and concentration of sialic acid receptors varied by tissue; those used by human and duck viruses were more prominent in the mammary gland and to a lesser degree in the respiratory tract, while those used by chicken viruses were more prominent in the respiratory tract and to a lesser degree in the mammary glands.

These findings provide insights into HPAI A(H5N1)’s tissue tropism in cattle and its transmission patterns. The presence of multiple types of species-specific receptors for influenza A viruses located throughout the dairy cattle also permits hypotheses on potential for them to serve as a mixing vessel for accelerated reassortment of influenza viruses, increasing a potential for the evolution of an influenza A virus with human pandemic potential.

Pasteurization and Food Safety

On May 1, 2024, the U.S. Food and Drug Administration confirmed that pasteurization inactivates H5N1 virus in a variety of milk products. No infectious H5N1 virus was found in nearly 300 retail dairy samples that were positive for viral nucleic acid by quantitative PCR. Additionally, neither viral nucleic acid nor infectious virus was found in retail powdered infant formula and powdered milk. This supports pasteurization’s effectiveness in inactivating concentrations of H5N1 virus found in the milk supply among samples collected in April. Advisories against consuming raw/unpasteurized milk or milk products remain in place.

Clinical Case in a Dairy Farm Worker

A recent study reported on the first reported human case of H5N1 infection in a U.S. dairy farm worker who experienced ocular discomfort without respiratory symptoms or fever. The worker had close contact with symptomatic dairy cows from farms with confirmed H5N1 infections. Personal protective equipment included gloves but no ocular protection. Swab specimens from the conjunctiva and nasopharynx confirmed H5N1 through RT-PCR and viral genome sequencing. Home isolation and oral oseltamivir were recommended, leading to resolution of conjunctivitis.

No secondary infections were reported among household contacts. Importantly, viral sequences showed no mutations suggesting changes in receptor binding or antiviral susceptibility. However, a mutation in the internal PB2 gene showed a change that is more commonly associated with human adaptation and warrants close monitoring.

Implications and Recommendations

These reports underscore the need for comprehensive HPAI A(H5N1) surveillance in agricultural settings. While cattle infections have been reported by the USDA to be generally transient with mild symptoms, the potential impact on milk production and food security is significant. The risk of ongoing viral evolution and broad transmission among cattle could lead to further mammalian adaptation. Although human infections from cattle seem to be rare at this time, the burden of infection necessitates detailed assessments of human spillovers, especially in areas with current or prior outbreaks. This includes serology to establish spillover rates to humans and monitor for changes in spillover frequency.

While the general public’s risk remains low, those at higher risk include individuals with routine or frequent contact with potentially infected birds, livestock, other animals or contaminated animal products and environments (e.g., farmers, livestock workers, animal handlers, employees of milk and meat processing facilities, milk or carcass transport drivers, and veterinarians).

Human infections with H5N1 can occur when the virus enters the eyes, nose, or mouth, or is inhaled. This can happen through airborne droplets, small aerosol particles, or dust that settles on mucous membranes. Infection can also occur if a person touches a contaminated surface and then touches their mouth, eyes, or nose. Exposed individuals should monitor for symptoms within 10 days, including fever (100°F [37.8°C] or higher), chills, cough, sore throat, difficulty breathing/shortness of breath, eye tearing, redness, or irritation, headaches, runny or stuffy nose, muscle aches, and diarrhea.

About the Authors

Syra Madad, DHSc, MSc, MCP, CHEP is an internationally renowned epidemiologist in special pathogens preparedness and response, biosecurity advisor and science communicator. She serves as the Chief Biopreparedness Officer at NYC Health + Hospitals, the U.S.’s largest municipal healthcare delivery system. Dr. Madad is a fellow at Harvard University’s Belfer Center for Science and International Affairs where she leads the Women in STEM and Diversity in STEM series; she’s Core Faculty at the National Emerging Special Pathogens Training and Education Center (NETEC), and affiliate faculty at Boston University’s Center on Emerging Infectious Diseases.

Her work focuses on the prevention, preparedness, response, and recovery from infectious disease outbreaks with an emphasis on healthcare and public health biopreparedness. She is known for her innovative strategies, which integrate emergency management principles with epidemiological methods, contributing significantly to the development of robust healthcare systems that can respond to emerging disease threats. You can follow her on X (twitter) and Instagram: @syramadad

Jason Kindrachuk, PhD is an Associate Professor, Canada Research Chair, Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.

Rick A. Bright, PhD is CEO, Bright Global Health and Former Deputy Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services.

Public Health Peril: The Fungus Among Us

Think fungal infections are just annoying skin irritations like athlete’s foot and jock itch? Think again. The rise of antifungal resistance means the game has changed. What was once a surefire treatment is now uncertain, and severe, life-threatening fungal diseases are on the rise.

Published May 22, 2024

By Brooke Grindlinger, PhD

Panelists Paul Verweij, MD, FECMM (left), Professor of Clinical Mycology at Radboud University Medical Center of Expertise for Mycology; Tom Chiller, MD, MPHTM (center left), Chief of the Mycotic Diseases Branch at the Centers for Disease Control and Prevention; and John Rex, MD, FACP (center right), Chief Medical Officer at the antifungal biotech F2G, Ltd.; speak with public health journalist and author Maryn McKenna (right) at SXSW on March 11, 2024. The panelists discussed the real-life challenges posed by fungi and why fungal infections are becoming harder to treat.

Fungi are everywhere: in the soil, on our skin, and in the air we breathe. They give us the cheese on our burgers and the beer and wine we love. Despite their benefits, fungi aren’t always our friends. Every day, we inhale up to 100,000 or more fungal spores—our immune system usually keeps infections at bay. Yet, out of the estimated 2-11 million fungal species, about 200 can make us sick. On March 11, 2024, the South by Southwest Conference panel “Will Fungi Be the Last of Us?,” moderated by public health journalist and author Maryn McKenna, explored how fighting harmful fungal species is a growing public health challenge.

The Agricultural Connection: How Fungicides Fuel Drug Resistance

While we may inhale numerous fungi, our primary defense against fungal infections is our body temperature—most fungi can’t survive the heat of our lungs and prefer cooler environments. However, certain fungal species like Candida auris and Aspergillus thrive at human body temperature and can cause severe disease in hospitalized patients with weakened immune systems. Panelist Paul Verweij, MD, FECMM, Professor of Clinical Mycology at Radboud University Medical Center of Expertise for Mycology, highlighted the threat of Candida auris: “This is a new yeast, which is emerging, and has spread all over the world since 1996. One of the problems with (it) is that it is drug resistant.”

Dr. Verweij explained that exposure to agricultural azoles, chemical fungicides used on food crops, has driven this fungus to develop resistance to azoles. “The problem we face in hospitals is that we use the same type of drugs to treat our patients,” Verweij lamented.

The panel highlighted the urgent need for a comprehensive approach to the development of agricultural fungicides that do not have harmful ramifications for human health. Panelist John Rex, MD, FACP, Chief Medical Officer at the antifungal biotech F2G, Ltd., cited a 2023 concept paper issued by the US Environmental Protection Agency and developed in collaboration with the US Department of Health and Human Services, the US Department of Agriculture, and offices within the White House Executive Office of the President.

The paper, titled Concept for a Framework to Assess the Risk to the Effectiveness of Human and Animal Drugs Posed by Certain Antibacterial or Antifungal Pesticides, sought public feedback on potential solutions, research, or mitigation approaches to reduce the spread of antimicrobial resistance (AMR). Panelist Tom Chiller, MD, MPHTM, Chief of the Mycotic Diseases Branch at the Centers for Disease Control and Prevention added, “The key is that we’re bringing groups together that don’t traditionally talk. We need to recognize that we each have problems that are going to be solved with these medicines. But how do we do it together so that we don’t affect that critical treatment [for a] patient with a fungal disease?”

Rising Temperatures, Rising Threats: Fungi in a Changing Climate

Dr. Chiller also emphasized the impact of climate change on the evolution of fungal species. “Fungi live out in the environment. If the environment changes—and climate change is causing environmental changes—the fungi have to adapt. They are going to try to tolerate higher temperatures. We need to understand that more.” Chiller pointed to Valley Fever, caused by the soil-based fungus Coccidioides: “It’s mainly in the Southwest [of the US], but now we know that the geographic area of this fungus is spreading. I have to think that climate change is playing a role.”

Closer Cousins Than You Think

Dr. Rex highlighted a critical difference in treating bacterial versus fungal infections. “You’ve heard of things like penicillin, sulfa [drugs], and erythromycin. There are at least a dozen completely different kinds of treatments for bacterial infections.” In contrast, Rex noted, “for fungi, there are only three major classes. The reason …. is that, believe it or not, one of your closest cousins is the fungi. We’re quite closely related, genetically. To find something that just kills the fungus and not the person, that’s hard. There are very few novel classes [of antifungal drugs] and each one we find is a precious jewel.”

Rapid diagnosis of fungal infection also remains challenging. Patient symptoms are often non-specific, and the sensitivity and specificity of available tests vary widely. Dr. Verweij shared his clinical experiences: “With only two classes of drug treatment available for Aspergillus infection, resistance to one treatment leaves the physician with just one drug to administer to the patient.” He highlighted the severe toxic side effects and the limited reach of these drugs. “If the infection spreads from the lung to the brain, then it’s extremely difficult to treat, and you can end up with an untreatable infection.”

Reviving Antimicrobial Development: The Promise of the PASTEUR Act

“Over the past decade, we’ve had several new antibiotics get approved, and then the companies go bankrupt,” Dr. Rex noted. He emphasized the importance of creating a sustainable financial model for developing and distributing new antimicrobials. “I’m very concerned that the ecosystem of people who know how to invent these drugs is drying up,” he warned. Dr. Rex shared his 15-year involvement in the development of the Pioneering Antimicrobial Subscriptions To End Upsurging Resistance Act of 2023 (PASTEUR Act).

This bill, re-introduced in the US Senate in April 2023, aims to stimulate innovative drug development, improve the appropriate use of antibiotics, and ensure domestic availability of critical need antimicrobial medicines to prevent AMR from becoming the next global pandemic. The PASTEUR Act proposes an innovative payment model where the US federal government invests $6 billion over 10 years in novel antibiotics and antifungals through installment payments. In return, developers would provide their drugs free of charge to government programs once available. This initiative is designed to foster much-needed investment and prepare the nation’s health care system for the increasing threat of antibiotic- and antifungal-resistant infections.

Antifungal Development in the AI Era

Conference discussion also centered on the pervasive influence of artificial intelligence (AI) across diverse industries and its role in antifungal development naturally emerged. Dr. Rex emphasized the immense potential of AI tools in assessing the toxicity risks associated with promising molecules identified during drug development. He noted, “That has, so far, evaded all simple prediction tools.”

Learn more about the dual nature of fungi—beneficial allies and deadly foes—at the July 18, 2024 hybrid Academy event featuring a conversation with mycologist, immunologist, and author Arturo Casadevall, MD, PhD, about his new book, What if Fungi Win?

Building Trust Through Transparency in Biorisk Management

A group of people sit around a u-shaped table in a boardroom.

Note: The reflections in this blog are of Dr. Syra Madad and Dr. Filippa Lentzos and do not represent the viewpoints of TAG-RULS DUR, the World Health Organization or The New York Academy of Sciences.

Published May 13, 2024

By Syra Madad and Filippa Lentzos

First meeting of the Technical Advisory Group on the Responsible Use of the Life Sciences and Dual-Use Research in Geneva on 16-17 April 2024. Photo courtesy of Marc Bader/WHO.

In September 2022, the World Health Organization (WHO) marked a significant milestone in global health security by issuing the Global Guidance Framework for the Responsible Use of the Life Sciences, aimed at setting a global standard for mitigating biorisks and governing dual-use research. More recently, the WHO set up a Technical Advisory Group on the Responsible Use of the Life Sciences and Dual-Use Research (TAG-RULS DUR) to support implementation of the Guidance Framework, and as members of that group we had the privilege of participating in its first in-person meeting at the WHO headquarters in Geneva, Switzerland. This historic gathering underscored the critical need for communication, collaboration, and coordination.

Prior to the meeting, we reflected on a crucial lesson gleaned from the COVID-19 pandemic: the imperative to rebuild trust in science. Drawing from our expertise in biosecurity and biorisk management, we discussed the foundational principle for fostering global trust in science: transparency in biosecurity risk management.

Transparency in Biorisk Management

Transparency in biorisk management involves several layers, from disclosing research methodologies to sharing findings and potential risks associated with biological advances. This transparency is crucial not only for advancing scientific knowledge but also for maintaining public trust, understanding and engagement. To effectively unpack the concept of transparency in biorisk management, let’s consider its practical application across different dimensions. These layers of transparency are not just theoretical; they are implemented through specific practices that are essential for maintaining the integrity and trustworthiness of scientific research. Here are three critical aspects where transparency plays a pivotal role:

1. Disclosing Research and Outcomes

It is essential that scientific endeavors, especially where dual-use potential is high, are conducted as openly as possible, and that the intent, potential benefits and potential harms of the research are clearly communicated. This openness helps the scientific community and publics to better understand risk-benefit assessment associated with the research, as well as fosters an informed dialogue about what constitutes responsible science in this context and what safeguards might be necessary.

2. Engagement with Public and Stakeholders:

Effective risk communication is a vital aspect of transparency. It involves clear, consistent, and accessible information being provided to the public. In addition to scientists, our discussions highlighted the role of various stakeholders, including funders, publishers and host institutions, in disseminating balanced and factual information to demystify scientific processes and debunk myths and misinformation.

3. Collaborative Governance

The governance of dual-use research requires cooperation across national and international frameworks. By sharing best practices, challenges, and successes in a transparent manner, countries and institutions can better prepare and respond to biosecurity risks. Collaborative governance also includes public engagement in policy-making, ensuring that the voices of affected, or potentially affected, communities are heard and considered.

In our continuous journey towards safer and more secure scientific practice, the role of transparency cannot be overstated. It is not merely a procedural element but a foundational principle that supports the entire framework of responsible life sciences research.

By adhering to transparent practices, we not only safeguard against misuse but also build a more resilient trust in science that is crucial for societal advancement. Transparency, engaged governance, and robust stakeholder communication are not optional but essential to our collective efforts in ensuring the safe use of biotechnologies. The path forward is clear; it is one of openness, engagement, and unwavering commitment to global health security.

The Role of TAG-RULS DUR

The WHO’s Technical Advisory Group on the Responsible Use of the Life Sciences and Dual-Use Research (TAG-RULS DUR) plays a pivotal role in advising WHO and its Member States on the responsible use of life sciences, focusing on mitigating biorisks and governing dual-use research. Our mission aligns with the One Health approach, which optimizes the health of people, animals, and ecosystems, and recognizes the interdependence of health and biological sciences. The group’s formation reflects a collective commitment to address safety and security concerns posed by novel and existing technologies, which, while promising, can also harbor potential risks for accidental or deliberate harm. Learn more about TAG-RULS DUR.

Dr. Syra Madad (left) and Dr. Filippa Lentzos (right) at the World Health Organization Headquarters.

About the Authors

Syra Madad, D.H.Sc., M.Sc., MCP, CHEP is an internationally renowned epidemiologist in special pathogens preparedness and response, biosecurity advisor and science communicator. She serves as the Senior Director of the System-wide Special Pathogens Program at NYC Health + Hospitals, the U.S.’s largest municipal healthcare delivery system. Dr. Madad is a fellow at Harvard University’s Belfer Center for Science and International Affairs where she leads the Women in STEM and Diversity in STEM series; she’s Core Faculty at the National Emerging Special Pathogens Training and Education Center (NETEC), and affiliate faculty at Boston University’s Center on Emerging Infectious Diseases.

Filippa Lentzos is the Reader (Associate Professor) in Science & International Security at King’s College London. She holds a joint appointment in the Department of War Studies and the Department of Global Health & Social Medicine.

Read more from Dr. Madad on the Academy blog:

The COVID-19 Pandemic at Year Four: The Imperative for Global Health Solidarity

Crossing Species: The Rising Threat of H5N1 Bird Flu in the U.S.

Crossing Species: The Rising Threat of H5N1 Bird Flu in the U.S.

The CDC recently confirmed a human case of HPAI A (H5N1) in Texas. Renowned epidemiologist Syra Madad and distinguished virologist Jason Kindrachuk offer tips to farmers, animal caretakers, and the general public on how to avoid contracting and spreading this strain of avian influenza.

Published April 16, 2024

By Syra Madad, D.H.Sc., M.Sc., MCP, CHEP and Jason Kindrachuk, PhD

Avian influenza H5N1, commonly known as bird flu, is a viral infection that affects both domestic and wild birds, along with a wide array of other animals. First identified in 1996, H5N1 has recently re-emerged in a significant panzootic form, specifically clade 2.3.4.4.b, impacting a broad spectrum of wildlife and domestic animals, including more than 200 mammal species.

Concerningly, this has included confirmed infections among numerous species not previously known to be susceptible to H5N1, including marine mammals, as well as in agricultural mammalian species such as cattle and goats. The rapid geographic expansion to all continents except Australia is also concerning. This notable spread across species is particularly alarming due to the potential for severe illness and death in humans as well as economic and food security impacts. This includes both within the agriculture industry as well as among communities reliant on wild game as a food source.

Confirmed Case in Texas

In March, the CDC confirmed a human case of HPAI A(H5N1) in Texas, related to contact with infected dairy cattle, marking the first recorded instance of probable mammal-to-human transmission in the U.S., and the second human case since 2022. Although human infections are rare and no sustained human-to-human transmission has been reported in the U.S., this event underlines the real risk H5N1 poses to individuals in close proximity to infected animals or contaminated environments.

Of note, a single mutation previously found to be associated with adaptation to mammalian hosts was identified within the viral genome sequence isolated from the recent U.S. case (PB2 E627K). However, while this demonstrates the need for continued surveillance and analysis of H5N1 genome sequences, there is no current evidence suggestive of altered human-to-human transmission for the virus or increased antiviral resistance. The CDC currently deems the risk to the broader U.S. populace as low; nevertheless, people with unprotected, extended exposure to infected birds or animals, or to contaminated areas, are at an elevated risk of contracting the virus.

The table below outlines recommended preventive measures for both the general public and those at heightened risk due to their work or recreational activities, aiming to reduce the likelihood of H5N1 infection.

About the Authors

Read more from Dr. Madad on the Academy blog: The COVID-19 Pandemic at Year Four: The Imperative for Global Health Solidarity

Jason Kindrachuk, PhD is an Associate Professor, Canada Research Chair, Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada

Women’s Health 2.0: The AI Era

Charting the evolution of women’s healthcare in the AI era, illuminating the promise and challenges of predictive tech to close the health gender gap.

Published April 12, 2024

By Brooke Grindlinger, PhD

Panelists Sara Reistad-Long (left), Healthcare Strategist at Empowered; Alicia Jackson, PhD, Founder and CEO of Evernow; Christina Jenkins, MD, General Partner at Convergent Ventures; and Robin Berzin, MD, Founder and CEO of Parsley Health speak at SXSW on March 9, 2024. The panelists discussed the promise and risks that AI and predictive tech carry as a path to closing the healthcare gender gap.

Less than 2% of global healthcare research and development is dedicated to female-specific conditions beyond cancer, as was starkly revealed in the January 2024 World Economic Forum and McKinsey Health Institute report, “Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies.” Rectifying this disparity holds the potential to inject over $1 trillion annually into the global economy by 2040 through bolstered female workforce participation. In February 2024, America’s First Lady Jill Biden unveiled a $100 million federal funding initiative for women’s health research, marking a significant milestone for the White House Initiative on Women’s Health Research intended to fundamentally change how the US approaches and funds research in this area. On March 9, 2024, the South by Southwest Conference hosted a pivotal panel discussion titled “Can AI Close the Health Gender Gap?” moderated by Sara Reistad-Long, a Healthcare Strategist at Empowered. This gathering of clinicians, digital health tech executives, and investors delved into the transformative potential of artificial intelligence (AI) and predictive technology in mitigating gender disparities in healthcare.

Women’s Health Beyond Reproduction

The panelists began by establishing a shared definition of ‘women’s health.’ Historically, women’s health has been narrowly defined as reproductive health, primarily concerning the female reproductive organs such as the uterus, ovaries, fallopian tubes, and to some extent, breasts. Yet, as panelist Christina Jenkins, MD, General Partner at Convergent Ventures, aptly pointed out, the scope of women’s health transcends this narrow scope. “There’s so much more to women’s health than that,” she emphasized, advocating for a broader understanding. “We consider ‘women’s health’ as a specific practice… focused on things that are unique to women, which are those reproductive organs and [associated conditions], but also conditions that disproportionately… or differently affect women.” She elaborated with examples ranging from autoimmune diseases to conditions like migraine, colon cancer, and variances in women’s reactions to asthma medications.

Overlooked and Underserved: Women’s Health Blind Spots

The historical exclusion of women from health research and clinical trials has perpetuated the flawed assumption that women’s bodies and health outcomes mirror those of men, neglecting their unique biological and medical complexities. “Women were not included in medical research until 1993. Women are diagnosed later in over 700 conditions. Some of our most pressing chronic conditions that are on the rise take 5-7 years to be diagnosed—like autoimmune conditions—and 80% of them occur in women,” observed panelist Robin Berzin, MD, Founder and CEO of digital health company Parsley Health.

AI’s Promise in Closing the Research to Practice Gap

Alicia Jackson, PhD, Founder and CEO of digital health company Evernow, which is focused on women’s health at ages 40+, has spearheaded groundbreaking research that has yielded one of the most extensive and diverse datasets on menopause and perimenopause. This dataset encompasses a multifaceted understanding, ranging from the manifestation of bodily symptoms during these life stages to the impact of variables such as race, ethnicity, income levels, hysterectomy status, and concurrent medications on patient outcomes. Furthermore, Jackson and her team have identified treatment protocols associated with both short-term relief and long-term health benefits. Despite possessing this wealth of information, Jackson posed a critical question: “I now have this massive dataset, but how do I actually get it into clinical practice to impact the woman that I am seeing tomorrow?” “There’s a huge opportunity for us to leverage clinical data in new ways to give us insights to personalize care,” added Berzin.

From Data Deluge to Personalized Care

Despite the increasing availability of rich research data on women’s health, significant challenges persist in promptly translating this data into effective patient care. With over a million new peer-reviewed publications in biomedicine added annually to the PubMed database, the sheer volume overwhelms individual healthcare providers. “That’s an impossible sum of research for any individual doctor…to digest and use,” observed Berzin. “New information takes 17 years to make its way from publication into medical education, and then even longer into clinical practice,” she lamented. “What I’m excited about when it comes to AI and closing the gender gap is the opportunity for us to close the research gap. What AI will let all of us do is take in a lot of the data sets that have been unwieldy in the past and leverage them to personalize care. The rapidity and pace at which we can begin to gain insights from the data, which is otherwise like drinking from a fire hose, represents an opportunity for us to catch up [on] that gender gap.” Jackson added, “AI gives me a time machine…to immediately take those results and apply them and impact women today.”

AI Nurse Anytime, Anywhere

The conversation shifted to AI’s potential to address the critical shortage of healthcare providers in the United States. Berzin highlighted the systemic issues, stating, “We don’t have enough doctors. We are not training enough doctors. We are not importing enough doctors. We have really big disparities in terms of where the doctors are.” Jackson expanded on the role of AI beyond tackling the provider shortfall and fast-tracking diagnostic processes, emphasizing its potential to facilitate culturally sensitive care. She emphasized that AI could go beyond delivering data and outcomes; it’s about understanding the nuances of cultural preferences in healthcare delivery. Jackson noted that women want more than just symptom discussion; they want to delve into the emotional and relational impacts of navigating the healthcare system. “Right now, no traditional healthcare system has time beyond that 15-minute appointment to listen and to understand.” However, AI offers the possibility of unlimited time for patients to share their experiences. With the assistance of AI, patients can access personalized care on their terms, allowing for a more enriching and fulfilling healthcare experience. Jackson continued, “If you have a $9 per hour AI nurse that can take that entire [patient] history, that [the patient can] call up in the middle of the night, on your commute to work, and just continue to add to that [history]…now you’ve created this very, very rich experience. Suddenly, it’s healthcare on your terms.”

Women’s Patient Empowerment Through AI

In addition to its potential to enhance healthcare accessibility and availability, AI emerged as a catalyst for empowering women to take charge of their healthcare journey. Jackson underscored a prevalent issue in women’s healthcare: the need for multiple doctor visits before receiving a correct diagnosis. She highlighted AI’s transformative potential in bridging this gap by empowering women to input their symptoms into AI platforms like ChatGPT, potentially integrating data from wearable devices, and receiving informed guidance—such as urgent care recommendations—immediately. This represents a significant stride in patient empowerment.

AI’s Achilles’ Heel

However, Jenkins cautioned against the pitfalls of AI, citing the case of Babylon Health, a UK-based digital health service provider. She recounted a troubling incident where the Babylon Health AI platform, during a system test, misdiagnosed a woman experiencing symptoms of a heart attack as having an anxiety attack, while advising a man with the same symptoms and medical history to seek immediate medical attention for a heart attack. “This is what happens when you build something well-meaning on top of bad data,” cautioned Jenkins. She went on to emphasize the critical need to use real-world evidence to mitigate gender biases entrenched in clinical research data. “There is an imperative, not just for the algorithms to eliminate bias, but to make sure that the data sources are there. That’s why we have to use real-world evidence instead of clinical research.”

Learn more about the opportunities and challenges surrounding the integration of AI-driven technologies into the healthcare system at the upcoming Academy conference: The New Wave of AI in Healthcare 2024, May 1-2, 2024 in New York.

Rule Makers and Breakers in the Space Race for Off-Earth Resources

From space junk to mining critical minerals on the Moon, this South by Southwest panel explored ambiguities in the governance of space ventures.

Published March 28, 2024

By Brooke Grindlinger, PhD

Panelists Monique M. Chism, PhD (left), Under Secretary for Education at the Smithsonian Institution; Aida Araissi, Founder and CEO of the Bilateral Chamber of Commerce; Kirsten Bartok Touw, aerospace, space, and defense tech investor and Co-Founder and Managing Partner of New Vista Capital; and A.J. Crabill, National Director of Governance for the Council of the Great City Schools; speak at SXSW on March 11, 2024. The panelists discussed the need for a cohesive and forward-looking governance approach to the business of space, to ensure equitable access and opportunity for all in this growing industry.

Space exploration not only signifies a pioneering frontier for deepening our comprehension of the universe but also serves as a pivotal gateway to unprecedented resources, technologies, and job opportunities, poised to emerge both on and beyond Earth’s bounds. What was once exclusively the domain of national governments has now evolved into a thriving commercial industry, fueled by the burgeoning participation of the private sector in space exploration. To guarantee the safety, accessibility, and positive impact of space exploration, it’s imperative to develop evolving governance mechanisms that effectively oversee resource allocation, foster international collaboration, prioritize safety and security, address ethical dilemmas, and tackle the escalating challenges of space debris and traffic management. On March 11, 2024, a diverse assembly of space investors, public and private stakeholders, ethicists, and enthusiasts congregated at Austin’s South by Southwest Conference to glean insights from the panel session titled ‘Governance Beyond Gravity: Unity & Exploration,’ helmed by Dr. Monique M. Chism, Under Secretary for Education at the Smithsonian Institution.

Satellite Superhighway: Redefining Space Access

Amid our captivation by the human presence aboard the International Space Station, the allure of Mars exploration, and the awe-inspiring vistas from the James Webb Space Telescope, it’s easy to overlook the bustling thoroughfare of satellites silently navigating Earth’s orbit. Remarkably, data from the tracking site Orbiting Now reveals a staggering count of over 9,600 satellites currently overhead, with SpaceX‘s Starlink network alone accounting for more than 6,000 of them.

The burgeoning satellite network not only amplifies global connectivity and intelligence capabilities but also signifies a democratization of space access, with over 70 nations, in conjunction with numerous private sector entities, having effectively launched satellites into low Earth orbit, endowing their operators with advanced communication and intelligence resources. The acquisition of precise Earth observation data, down to the millimeter level, fuels unmatched insights, opportunities, and competition.

Fellow panelist, Kirsten Bartok Touw, an aerospace, space, and defense tech investor and Co-Founder and Managing Partner of New Vista Capital underscored, “The concept of national security and protecting your country’s and your allies’ access to space, and all that is up there, is incredibly important.” However, Bartok Touw proposed that this unique and specialized business sector should not solely reside within the purview of governments. “We need to work with commercial companies—they iterate, they move faster, they design.” Beyond intelligence applications, Bartok Touw highlighted the numerous commercial opportunities in space, ranging from asteroid and lunar mining for rare Earth minerals to satellite monitoring for methane leaks, and even drug discovery, which can occur at an accelerated pace due to the absence of gravity in space. “This is a race for unexplored capabilities and areas. The first companies up there to lay claim are going to be the furthest and most advanced.”

Space Governance in Flux: Challenges and Opportunities

In the absence of established human settlements in space or local space governments, the space community navigates a complex web of governance policies crafted over decades. These include the foundational Outer Space Treaty of 1967, ratified by 112 nations, the 1979 Agreement Governing the Activities of States on the Moon and Other Celestial Bodies, colloquially known as the ‘Moon Agreement,’ ratified by a mere 18 nations, and the recent non-binding 2020 proposal, the Artemis Accords, which serves as an international legal framework aimed at orchestrating the peaceful exploration and utilization of space resources.

Panelist A.J. Crabill, National Director of Governance for the Council of the Great City Schools in Washington DC offered insights into the pivotal role of space, and space governance, in shaping the future of our society. “That future requires stepping out of our birthing cradle and being able to access resources beyond those that are terrestrial. However, the moment you have a lot of people doing that you’re immediately going to run into conflict. That’s when the need for systems of governance come into place. How do we protect both people and resources [and] how do we collaborate effectively around services that are needed? All of those become way more complicated outside of Earth’s atmosphere.”

Bartok Touw flagged that prior space governance policies relied on country-to-country agreements. But today, independent commercial operators like SpaceX, which launch and lease satellites for a variety of government and private entities, can limit the access that a country or corporation has in their region to space-based communications. “The state-to-state agreements that we had earlier [are] being disrupted today because now it’s not just country-to-country… it’s commercial entity-to-commercial entity. I would love to live in a world where all these nations and commercial entities could agree, but that is not the case we’re in.”

Panelist Aida Araissi, Founder and CEO of the Bilateral Chamber of Commerce, injected some optimism into the discussion, remarking, “The countries that are at the forefront of accessing the Moon are [the United States], the Soviet Union, China, and India. It’s an exciting time.” However, as humanity’s quest to return to the Moon and journey to Mars intensifies, Araissi raised concerns about the governance of commercial activities, such as lunar mining. “Exactly whose jurisdiction is that, and how are we going to regulate that? That is the key question.” Bartok Touw echoed, “That is the problem, there isn’t an enforcing mechanism.”

Crabill adopted a pragmatic stance, invoking the satirical adage, “He who has the gold makes the rules.” He elaborated, “Unfortunately, we see this time and time [again] when we’re looking at governance systems—school systems, states, cities, nations—whoever has the keys of authority…the access to resources, does wind up making the rules. If we want space governance to follow our values, we have to be there first in a powerful way, establish industry, and establish resources. And then our values of bringing other people in coalition can be what carries the day.”

Reflecting on the evolution of space governance, Crabill noted that reaching consensus was easier during the theoretical discussions of the 1950s and 1960s. However, as society approaches the technological reality of widespread space access, the complexities of governance intensify. “Governing the imminent is much more complicated than governing the hypothetical.”

Learn more about the ethical, legal, and social issues relevant to space exploration and long-term human settlement in space at the upcoming event featuring a conversation with space ethicist, astrophysicist, and author Erika Nesvold: Off-Earth: Ethical Questions and Quandaries for Living in Outer Space.

Tales In New Urban Sustainability

From global data-sharing efforts to local educational campaigns, new urban sustainability projects are shaping the cities of a greener future.

In 1900, about 13 percent of the world’s population lived in cities. Today, well over half of it does, and that proportion continues to grow. Cities now account for three-fourths of global gross domestic product, and about the same fraction of human-generated carbon emissions.

Because they concentrate huge amounts of human activity into small areas, cities are ideal test beds for new sustainability efforts. Inspired by the United Nations’ Sustainable Development Goals (SDGs) new collaborations have sprung up between political leaders, scientists, communities and non-governmental organizations. From global data-sharing efforts to local educational campaigns, these new urban sustainability projects are shaping the cities of the future.

The Political Climate

Nations formally sign international agreements such as the SDGs, but in the case of urban sustainability, it falls to the leaders of individual cities to implement relevant policies. Fortunately, compared to national or regional governments, “cities are much more in tune with the direct impact of their policies, and they are much more in tune with the quality of life of citizens … from day to day,” says Christiana Figueres, Vice Chair of the Brussels-based Global Covenant of Mayors for Climate and Energy.

Figueres’ group provides a global network through which city leaders can share their ideas and results in pursuing sustainability.

“We’re a very important platform for city officials to learn what has worked,” says Figueres, pointing to examples such as Seoul’s renewable energy campaign, Paris’ expanding bicycle infrastructure, and a multi-city effort in India that has exchanged over 700 million incandescent lightbulbs for high-efficiency ones.

The central focus of the Global Covenant of Mayors is helping cities design and implement ambitious climate action plans, but that remit intersects with many of the U.N.’s other SDGs.

“How we pursue building our cities for the future — such as using high-carbon or low-carbon infrastructure, the way we change our consumption and production patterns, the way we deliver economic growth — are all relevant to the sustainable development goals and will largely determine the quality of life on this planet,” says Figueres.

United by Common Problems, Divided by Different Regulations

While cities around the world face common problems, they’re also bound by the particular laws and circumstances of their nations. Figueres emphasizes that the Global Covenant of Mayors has neither the authority nor the desire to try to synchronize urban policies across national boundaries. Instead, the group serves as a clearinghouse for cities to share data, strategies and ideas and discuss their experiences and results.

Science is a central part of all of these efforts, in measuring greenhouse gas emissions, studying and predicting the potential impacts of future climate change and also identifying the most effective measures cities can take to reduce their environmental impact and mitigate risks. Figueres points to a project in Myanmar, where scientists are developing models that can predict storm surges from cyclones, and others that identify areas at the highest risk of earthquakes and fires.

That information will help local leaders plan disaster responses to focus on the areas with the greatest needs, while also guiding future infrastructure development. Data from that project could inform similar efforts in coastal cities around the world, as rising seas and temperatures will likely make natural disasters more frequent.

Fundamentally a Problem of Physics and Atmospheric Chemistry

Climate change is fundamentally a problem of physics and atmospheric chemistry, but responding to it will require many other disciplines. Figueres emphasizes that in cities especially, researchers need to focus on social aspects of sustainability.

“We have a tendency to dehumanize cities, as though the purpose of cities were to have buildings and infrastructure, [but] the purpose of cities is actually to be the home for human beings,” says Figueres.

For policymakers to make the best use of science, scientists also need to explain it in human terms. “It does no good to come with science, accurate as it may be, if it’s not made relevant and understandable,” says Figueres.

Melanie Uhde
Photo: Sun Kim, skstudiosnyc

Hungry For Change

While the Global Covenant of Mayors is helping scientists and city leaders work together globally, individual researchers are also taking local action in their own towns. New York’s Urban17 Initiative exemplifies this trend.

“I wanted the students who are part of our team to focus on urban sustainability in New York City, because it’s a great city to model hypotheses,” says Melanie Uhde, Urban17’s founder and managing director.

Urban17 currently consists of about a half-dozen volunteer analysts, mostly graduate students and young researchers from different disciplines and universities around the city. Despite its small size and lack of funding, the ambitious group is already tackling a project with global relevance, studying the overlapping problems of obesity and hunger.

“We know that, for example, the rates of obesity and hunger in the Bronx are the highest [in the city], so they’re basically bedfellows, which is a very common phenomenon in urban environments throughout the world,” says Uhde.

The Paradoxical Overlap of Hunger and Obesity

It may seem paradoxical for hunger and obesity to overlap, but interconnected problems can yield exactly that result.

“It’s definitely poverty, but it’s unfortunately much more complicated,” says Uhde, adding “even if you have money, do you have access to food, do you have the education, do you know what’s actually good for you, [and] do you have the time to put effort into a nutritious meal?”

In poor urban neighborhoods, the answers to those questions are often ‘no,’ causing synergistic deficits that can produce the entire spectrum of dietary problems. To address that, Uhde and her team are combining data on obesity and hunger with the locations of groceries, parks, fitness centers and schools.

The Impact of Obesity and Hunger on Education

Public schools provide good anchors for the project, not only in mapping the extent of obesity and hunger in some of the most vulnerable populations, but also in implementing solutions.

“Education is a very important factor to achieve sustainability, and we’re seeing [how] other factors like obesity or hunger influence education,” says Uhde. Malnourished students aren’t likely to learn well, which in turn can perpetuate poverty and poor health. Improving school meal programs and health classes could help break that cycle.

Uhde hopes other scientists will start tackling sustainability problems in their own towns. “Sustainability … affects everyone in every aspect of life,” she says, adding that “we’re living in this era where we have to do something no matter what.”

Jennifer Costley, PhD, Director, Physical Sciences, Sustainability and Engineering, New York Academy of Sciences contributed to this story.

Also see: Infrastructure Architecture Framework: A multi-sector approach to enterprise systems
engineering and management

International Science Reserve: The Evolution of a Global Scientific Readiness Force

By Dario Gil, SVP and Director of Research, IBM

In June 2020, we were all in one of the first waves of the still-ongoing COVID-19 pandemic, which had crippled our world. And back then, neither I nor anyone else could anticipate just how much damage and dread this disease would bring – and for many, feelings of uncertainty and nervousness about the future just wouldn’t go away.

But many of us were already thinking ahead. This crisis would eventually end, we assumed. But it most likely wouldn’t be the last one. In my conversations with leaders across governments and industries, there was a common thread from us all: we wanted the world to be ready for the next crisis ahead of time.

Today, this vision is becoming a reality with the International Science Reserve (ISR), powered by The New York Academy of Sciences with participation from IBM and other public and private sector leaders. This new organization intends to become a nimble network of academia, industry, and government, blurring geographical borders to collaboratively prepare for the next global emergency. Although ISR is at the very dawn of our journey – I am confident we will make a difference when the next crisis strikes.

We are confident in the ISR approach because we have a great example to learn from – the COVID-19 High-Performance Computing (HPC) Consortium.

Early at the start of the pandemic, our teams at IBM rapidly mobilized thousands of researchers to help fight the deadly virus. We weren’t working in a vacuum – a few months earlier, IBM, the White House, and the US Department of Energy had launched a new global body called the COVID-19 HPC Consortium. This organization rapidly expanded to include many partners from academia, industry, and US national labs, pooling together the world’s most powerful high-performance computing resources to offer to scientists fighting the disease.

Working together, the HPC Consortium (HPCC) was able to quickly aggregate and open unfettered access to the power of dozens of supercomputers to scientists searching for a vaccine or treatment against the virus. The success of the HPCC demonstrated the power of what’s possible when we break down borders and red tape to quickly collaborate and accelerate science in times when it’s needed most.

Ultimately, the HPCC delivered steady results thanks to the efforts of our members and the researchers worldwide using its computing resources. With partners including Google Cloud, IBM, Intel, Microsoft, Amazon Web Services, NASA, MIT, NSF, the Department of Energy’s national labs, as well as government and academic organizations from beyond the US, the Consortium has so far helped more than 100 research teams to come up with new treatments, better understand the spread of COVID-19, and much more. Every milestone has been a testament to the crucial importance of global collaboration – and for the establishment of a new, broader, organization that would go beyond computing and enable us to prepare for future catastrophes from multiple fronts.

At IBM, we soon began to think about how we could make this broader vision a reality. An organization… a global body… always ready for ‘known unknowns’ and large-scale emergencies we could anticipate and prepare for ahead of time… similar to a military reserve always ready to defend in case of war.

Our world needs a reserve of scientists, of experts in different fields that would always be ready to address any future global crisis. An organization with the bottom-up nature of the reserve concept, comprised of researchers using the power of the network to prepare for a new emergency.

We know that another pandemic is very likely, possibly with some new, unknown pathogen. That the world will continue to have more devastating wildfires and deadly earthquakes. Cyberattacks could take out infrastructure on a massive scale and asteroids could threaten the Earth. That such ongoing problems as antibiotic resistance and climate change could trigger a catastrophe at any time. And if we start preparing for the next crisis early – unlike with COVID-19, scrambling in haste and panic – then we will be much more likely to save lives.

Over the past year, IBM has been working with The New York Academy of Sciences (NYAS) to establish the International Science Reserve (ISR) to execute this vision. The ISR is still a very young organization, but we are gathering steam. We have a vision. Together with global talent from various scientific and technological fields, we will have an invaluable reserve of expertise – much-needed to tackle a future emergency.

Let’s prepare for the next crisis – together.

When Waters Rise: Cross-Border Science for Global Flood Response

Around the world, flooding is wreaking havoc on people’s daily lives with increasing magnitude and frequency. Communities in Nigeria, Chad, Niger, Burkina Faso, Mali, and Cameroon are experiencing some of the worst floods in a decade, as they sweep across western and central African borders.

In Pakistan, the Philippines, Vietnam, Australia, and the United States—such as in Florida and Kentucky—communities have faced multiple dangerous and deadly floods in 2022. These unprecedented flood events have killed thousands of people, displaced millions, decimated farms and businesses, and destroyed homes and habitats.

The World Bank reports that about one and a half billion people are at risk from flooding, one-third of whom are living in poverty, making them more vulnerable to migration pressures and economic insecurity. While flooding can be a natural phenomenon that can help provide fertile soil and sustain wetlands, today’s floods are becoming more frequent, dangerous, and deadly, as a result of human-caused climate disruption and development in urban, coastal areas. 

When flood water crosses national borders, “transboundary floods” can be even more catastrophic without international cooperation around emergency management, such as early warning systems. In a recent Science Unusual webinar, hosted by the International Science Reserve, a group of panelists explored the role scientific and technical experts can play in large-scale, international flood prediction, prevention, preparation and response.

Speaking on the panel were:

Nora El-Gohary, Professor of Construction Engineering and Management, The Grainger College of Engineering, University of Illinois Urbana-Champaign
Njoki Mwarumba, Assistant Professor of Emergency Management and Disaster, University of Nebraska Omaha
Anthony Torres, Chief Meteorologist and Head of Global Science Operations, Currently weather service
Campbell Watson, Senior Research Scientist – IBM Research, Global Lead, Accelerated Discovery—Climate & Sustainability
Ugochi Anyaka-Oluigbo, Environment and Conservation Journalist, Nigeria (Moderator)

Here are three big takeaways from the discussion:

1. Breaking down borders between social scientists and other types of scientists who study floods will lead to better outcomes for people and communities.

Njoki Mwarumba kicks off the discussion on why we need to break down siloes.

Nora El-Gohary on how scientists can help reduce the impacts of floods on infrastructure.

2. Using atmospheric data to predict flooding impacts is just the beginning. Protecting the most vulnerable requires a stronger analysis on how the atmosphere interacts with oceanic and local land systems, and human habitats.

Anthony Torres on where meteorology interacts with other disciplines and AI to predict floods.

3. Scientists should work to understand indigenous knowledge in order to better collaborate on early warning systems that save lives.

Njoki Mwarumba discusses the impact of leaving entire regions out of advances in technology, like early warning systems.

Anthony Torres on building two-way streets of communication between communities and scientists.

4. Artificial intelligence is enhancing our ability to predict and prepare for floods. But we must simplify access to increasingly complex data processes and improve their usage across borders.

Campbell Watson shares his thoughts on AI and its impact on flood modeling.

Campbell Watson discusses how IBM is researching and responding to global floods.

Ethics in Pediatric Research

Recent progress in the understanding of human disease has led to an explosion in the number of new medicines and therapeutics available for adults — however, significantly fewer drugs are developed and evaluated specifically for children due to complex ethical and logistical issues. Listen to this podcast addressing topics on how to provide children with evidence-based treatments while protecting them from inappropriate research.

This podcast highlights discussions from the Ethical Considerations in Research for Pediatric Populations symposium presented by The New York Academy of Sciences and NYU Grossman School of Medicine and is made available thanks to funding provided by Johnson & Johnson.

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