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Saturday, Jan. 28, 2012
Balancing security and science
Scientists working on ways to detect and prevent the spread of the avian flu virus have suspended their work out of concern that it could either be used for bioterrorism or that it might escape the lab; either development could create a global pandemic and cost thousands, perhaps millions, of lives.
The decision to halt the research is temporary: A meeting of global health experts will be convened to decide how the work should proceed. It is a critical debate for which there are no easy answers. But agreeing on a process is essential given the magnitude of the risks in both directions.
The H5N1 bird flu emerged in Southeast Asia in the late 1990s. It was first detected in humans in Hong Kong in 1997; 18 people were diagnosed with the virus, six of whom died. It was thought that the disease had jumped species as a result of close exposure to infected animals in live bird markets.
While that hypothesis triggered mass culls, the virus continued to spread, reaching the Middle East, Europe and Africa. Up to now, 576 human cases have been reported and there have been 339 deaths. The human fatality rate ranges from 30 to 80 percent; experts consider this "one of the most virulent known human infectious diseases." Thus far, the virus is still transmitted from birds to humans, but scientists worry that the virus will mutate to facilitate human-to-human transmission. That would turn a dangerous disease into a deadly one, capable of sparking a pandemic on the scale of the 1918-19 outbreak of Spanish flu which killed as many as 40 million people.
Scientists have been trying to prepare for the possibility of that mutation, reasoning that if they can identify how it might occur, they can then create a vaccine that would be prepared ahead of time and avert a pandemic.
Recently, they succeeded, creating a mutant version of the virus that can be transmitted by respiratory droplets or aerosol between mammals (in this case, ferrets). They believe that human-to-human transmission is also possible.
Shortly after this "achievement," the research teams submitted their findings to two of the most respected scientific journals in the field for publication. At that point, the U.S. National Advisory Board for Biosecurity (NSABB) was asked to examine the issue. It recommended that the papers not be fully published; instead, the basic results should be provided without methods or detailed results. The government passed those recommendations on to the journals and the scientists. The scientists, and some colleagues, responded with a letter, published this month in the two journals, arguing that the research is crucial to public health efforts, but acknowledging the controversy, called for a 60-day suspension of research on the virus so that the scientific community could debate the issue. An international conference on the topic is now scheduled to be held next month at World Health Organization.
The agreement to suspend work is correct, given the stakes. Critics worry that the new virus might escape the laboratory and, upon entering the environment, spread rapidly, creating the nightmare scenario the research was designed to avoid.
They point out that viruses have already escaped biosafety Level 3 labs; for this group, only Level 4 labs, the most secure, will do. They also fear that terrorists might use or steal this research to create their own bioweapons.
Other critics make more prosaic, but equally compelling, charges: They argue that detecting an emerging pandemic virus in animals before it spreads to humans will not happen. They note that the six countries where the highly pathogenic H5N1 is endemic (Bangladesh, Cambodia, China, Egypt, Indonesia and Vietnam) do not have the capacity to detect and respond to the infections in birds. In other words, scientists would not be able to identify the strain — and hence counter it — until it was too late.
Supporters of the research say that the mutation is just too easy. A mere three molecular changes are required to make the virus transmissible by air. As one of the researchers concluded, the question is not whether these viruses can be transmitted by aerosol, but when it will happen in nature.
The debate raises fundamental questions about science and security; ultimately it asks, what constitutes progress? For some, it is a basic debate over risk and benefit. Should we risk huge dangers if their probability is low and the potential payoff from scientific research is high? Historically, scientists have pressed ahead with such endeavors, arguing that science is neither good nor bad.
For them the pursuit of knowledge has been an end in itself. They have comforted their conscience with the thought that the result is a tool that we as a species use in whatever form or fashion we choose. (Alternatively, they assert that their work provides security if "the wrong side" gets the results first.)
A complete and enduring suspension is unlikely. Thus, it is critical to use the lull to develop standards to ensure biosafety, biosecurity and sufficient oversight to protect against misuse or accidents. China has reported its second bird flu fatality this month, and Cambodia, Indonesia and Vietnam have had similar deaths. The need for preparation is increasing.
Just as important are detection and surveillance mechanisms, and the recognition by public health officials, of the dangers.