One of the two H5N1 influenza papers that fueled this brouhaha has finally seen the light of day. Rather than rehash what others have already said so well, I refer readers to the excellent summaries by Vincent Racaniello and Ed Yong.
The New York Academy of Sciences is hosting a panel discussion tonight about H5N1 influenza, “dual-use” research, and scientific censorship. Of course this stems from the ongoing debate about the alleged development of mammal-adapted H5N1 strains (see my earlier summaries here and here).
So far, I’ve found the public discussions on this issue disappointing, not only as a virologist and journalist, but also as a former debate coach. Both sides are advancing arguments, but there’s been a distinct lack of clash. In order to have a debate, each side has to listen to what the other is saying, and then respond directly, point-by-point, to the claims. Simply restating your own claims doesn’t cut it. If the arguments don’t clash, we can’t find out which ones are sound. Let me give some examples.
Members of the National Science Advisory Board for Biosecurity (NSABB) have made numerous public statements and published several essays about their recommendation to censor the new research. In all of those statements, they repeat the claim that H5N1 flu is a concern because it is highly lethal. In fact, they almost always quote a specific number: 59% of people infected with this virus die.
In blog posts and academic journal articles, virologists have repeatedly pointed out that this statistic is quite likely several orders of magnitude too high. The response of NSABB members has been simply to repeat the erroneous statistic. This is a crucial question that lies at the center of the debate, but there’s no clash.
Meanwhile, several commenters (including Howard Markel in an Op-Ed in today’s New York Times) have pointed out that redacting key data from the new papers, as the NSABB advocates, is a pointless gesture. As Markel explains:
In this case, censorship is too little, too late. The data generated by one of the research teams was already presented at a conference in Malta in September, where copies of the paper were distributed. But even if the data weren’t already available, the key details could likely be inferred from other information that is already available. I recently spoke with several prominent influenza scientists, all of whom agreed that, based on the knowledge that certain mutations can make H5N1 highly transmissible in ferrets, they could consult previously published literature and probably figure out what those mutations are.
In addition, none of this research was conducted in classified facilities. Hundreds of people without security clearances have already seen the data, which have also been emailed across multiple minimally-secured servers in at least four countries. If evil-doers wanted this information, it would be trivial for them to figure out which door to kick down to get it. The only people who actually can’t get access to the data are the scientists who might actually be able to use it beneficially.
The NSABB response to this criticism has been deafening silence. Again, it’s a crucial issue, but there’s no clash.
In the NSABB’s official policy statement explaining the rationale for their recommendations, we are simply told that they found the risks outweigh the potential benefits. For the past month, scientists have pressed the group, collectively and individually, to explain exactly what evidence they considered in reaching that conclusion. The policy statement, though, provides no more detail than their earlier editorials. So even when it comes to the central thesis of the argument, we have no clash.
At this point, I strongly suspect that the scientific backlash against the censorship recommendation took the NSABB by surprise. The group appears to have been looking for a test case on which to launch a discussion, and when the new H5N1 work came up they decided this would be it. Board members talked amongst themselves, made their recommendation on (probably inadequate) evidence, and expected the scientific community to go along peacefully. The scientists had other ideas. Having drawn a line in the sand, though, the NSABB now finds itself unable to retreat from it without looking foolish.
So here’s what both sides of the debate need to accomplish tonight. The virologists need to state their counter-arguments once more, but in the process they need to insist on direct responses from the NSABB. Don’t let them simply restate incorrect figures for the fatality rate, or just stipulate that redacting the data will prevent a terrible harm. Be nice, but press firmly. Don’t take “because we said so” for an answer. However, be sure you listen to the responses – it’s likely that NSABB members have some criticisms of the data you’re citing, and you’ll need to answer those as directly as you expect them to answer you.
The NSABB should begin by explaining their decision process, transparently and plainly, and acknowledging that it may have been flawed. Hey, we’re all people, and we all make mistakes sometimes. Next, address each and every one of the virologists’ counter-arguments directly. No dodging or pretending not to hear. Be prepared to concede any arguments for which you don’t have solid, evidence-backed answers. That will actually boost your credibility. Being wrong isn’t a character flaw. Being wrong while insisting you’re right is. On issues where you do have evidence, though, go ahead and press on. You had reasons for making the recommendation you made. Explain them. Finally, back off the fear button. Telling scientists that they have to agree with you or Congress will implement “Draconian restrictions on research,” or asserting (without solid evidence) that terrorists are on the verge of developing high-yield bioweapons, is fear-mongering. Stop it.
The recent dustup about The H5N1 Bird Flu Plague That Will Kill Us All (not) has brought the topic of “bioterrorism” into the media spotlight again. This is an issue I’ve been following for several years, and during that time I’ve come to a conclusion that’s pretty much the opposite of everything we’ve been told: biodefense is largely a waste of money.
Let’s start with the current definition of the problem. The US government has prepared a list of “select agents” that are considered potential biological weapons. Researchers who work on these agents have to get special clearances, and an entire multi-billion-dollar industry of defense contractors has sprung up to help the nation prepare for a terrorist attack using one of these weapons. I have two problems with this list.
First, several of the listed “agents” shouldn’t be treated as biological threats at all; they are chemical weapons. Botulinum toxin and ricin, for example, both appear on the list, but an attack with either of these toxins would bear no resemblance to a biological outbreak. Their toxicity is generally acute, so the first responders to such attacks would be police and firefighters, whereas the first responders to a true biological attack would be physicians and nurses. Toxins don’t reproduce or spread, so the response would be about containing and decontaminating the scene, not tracking contacts and cases. The list conflates two completely different types of threats. But perhaps that’s just a technical gripe.
The second problem is much more serious. Eliminating the toxins, we’re left with a list of infectious bacteria and viruses. With a single exception, these organisms are probably near-useless as weapons, and history proves it.
There have been at least three well-documented military-style deployments of infectious agents from the list, plus one deployment of an agent that’s not on the list. I’m focusing entirely on the modern era, by the way. There are historical reports of armies catapulting plague-ridden corpses over city walls and conquistadors trying to inoculate blankets with Variola (smallpox), but it’s not clear those “attacks” were effective. Those diseases tended to spread like, well, plagues, so there’s no telling whether the targets really caught the diseases from the bodies and blankets, or simply picked them up through casual contact with their enemies.
Of the four modern biowarfare incidents, two have been fatal. The first was the 1979 Sverdlovsk anthrax incident, which killed an estimated 100 people. In that case, a Soviet-built biological weapons lab accidentally released a large plume of weaponized Bacillus anthracis (anthrax) over a major city. Soviet authorities tried to blame the resulting fatalities on “bad meat,” but in the 1990s Western investigators were finally able to piece together the real story. The second fatal incident also involved anthrax from a government-run lab: the 2001 “Amerithrax” attacks. That time, a rogue employee (or perhaps employees) of the government’s main bioweapons lab sent weaponized, powdered anthrax through the US postal service. Five people died.
That gives us a grand total of around 105 deaths, entirely from agents that were grown and weaponized in officially-sanctioned and funded bioweapons research labs. Remember that.
Terrorist groups have also deployed biological weapons twice, and these cases are very instructive. The first was the 1984 Rajneeshee bioterror attack, in which members of a cult in Oregon inoculated restaurant salad bars with Salmonella bacteria (an agent that’s not on the “select” list). 751 people got sick, but nobody died. Public health authorities handled it as a conventional foodborne Salmonella outbreak, identified the sources and contained them. Nobody even would have known it was a deliberate attack if a member of the cult hadn’t come forward afterward with a confession. Lesson: our existing public health infrastructure was entirely adequate to respond to a major bioterrorist attack.
The second genuine bioterrorist attack took place in 1993. Members of the Aum Shinrikyo cult successfully isolated and grew a large stock of anthrax bacteria, then sprayed it as an aerosol from the roof of a building in downtown Tokyo. The cult was well-financed, and had many highly educated members, so this release over the world’s largest city really represented a worst-case scenario.
Nobody got sick or died. From the cult’s perspective, it was a complete and utter failure. Again, the only reason we even found out about it was a post-hoc confession. Aum members later demonstrated their lab skills by producing Sarin nerve gas, with far deadlier results. Lesson: one of the top “select agents” is extremely hard to grow and deploy even for relatively skilled non-state groups. It’s a really crappy bioterrorist weapon.
Taken together, these events point to an uncomfortable but inevitable conclusion: our biodefense industry is a far greater threat to us than any actual bioterrorists.
For comparison, Timothy McVeigh pulled a Ryder rental truck full of ammonium nitrate and fuel oil (both very easily obtained) in front of a Federal building, and killed 168 people. The 9/11 hijackers killed almost 3,000 people and blew up the headquarters of the United States military, using box cutters and basic flight training. In 2000, a couple of guys in an inflatable boat full of explosives totaled an American battleship. I could go on, but hopefully you get the point: conventional weapons are orders of magnitude more effective for terrorism than biological ones.
Astute readers may have noticed that I mentioned a single exception on the select agent list. I’m talking about smallpox, and the reason it’s an exception is interesting: it’s a good weapon only because we successfully eradicated it.
Had the World Health Organization focused on controlling smallpox instead of eradicating it, there would have been continued pressure to develop improved vaccines, and likely continued vaccination. That’s the pattern now with poliovirus, which has been incorporated into one of the standard combination vaccines that kids receive.
But because the WHO focused on eradicating smallpox instead, they stuck with the primitive vaccine originally developed in the 18th century by Edward Jenner. Once the world was certified smallpox-free, vaccination stopped. Now, nearly everyone born in the past forty years or so is susceptible to this highly contagious, highly lethal virus.
Smallpox would still be a very poor choice for bioterrorism, but for a different reason than the rest of the select agents. A terrorist group that actually got ahold of it could probably culture it and deploy it without much trouble – in many ways it would be easier to work with than anthrax. However, there is no question who would be hit hardest by a new global pandemic of smallpox: the poor countries. The US already stockpiles hundreds of millions of doses of smallpox vaccine and antivirals. Once an outbreak was identified, it would be straightforward to track and stop, at least in the developed world. The people who would suffer and die would be precisely the ones most terrorist groups are trying to represent. Military types call that “blowback,” and it’s a very bad thing.
So what should we do? First, stop panicking. Terrorist groups have repeatedly said they want biological weapons, but that’s either propaganda or fantasy. The groups that have actually pursued such weapons have found that they’re a complete waste of resources. However, the fear of bioweapons has caused governments around the world – particularly in the US – to spend billions of dollars on technologies they will never need. Spending the same money on our ailing public health system would have been a much better investment.
We should keep stockpiling vaccines and antivirals against smallpox, against the tiny but nonzero probability that some terrorist might actually have the contradictory combination of resourcefulness and stupidity necessary to get ahold of this virus, then deploy it. We should probably continue researching improved smallpox vaccines, too, if only because the work could yield useful insights about other, more relevant viruses. But most importantly, we should drastically reduce the size of our current “biodefense” efforts, which have unambiguously proven themselves to be more harmful than beneficial. Hiring and training more people to work with select agents is the problem, not the solution.
This afternoon, a coalition of influenza virologists released a statement saying that they are voluntarily suspending research on H5N1 “bird flu” for 60 days. This was in response to the Category 5 hype storm that has accompanied the publication of two papers about this virus. My previous post on this topic (and links therein) provides a quick review for those who haven’t been following this story.
I’m of two minds about the new moratorium. As a scientist, I think it’s moronic. H5N1 flu is biologically interesting, and could become a major public health concern if it ever manages to sustain human-to-human transmission. Though its lethality has probably been vastly overstated, there’s no doubt that it is capable of killing at least some people, under some circumstances. The demonstration that it’s possible for H5N1 to adapt to a mammalian host, even one that diverged from the primate lineage many millions of years ago, shows that we need to step up H5N1 research, not halt it.
However, the biodefense industry’s recent push to whip up fear has completely distorted the public’s perception of this issue. Millions of nonscientists are now convinced that the recent virus transmission work was dangerous, perhaps even foolhardy, and that terrorist groups could easily take advantage of the new findings to kill millions. None of that is even remotely true. Unfortunately, people who are in a panic aren’t capable of rationally evaluating the nuances, so the scientists who’ve been trying to defend ongoing H5N1 work are at a disadvantage. Saying they’ll suspend that work is the only reasonable public relations strategy at this point.
Around the same time the moratorium was announced, a partially overlapping group of virologists sent an open letter to the National Science Advisory Board for Biosecurity (NSABB), giving that board a thump on the head. It was the NSABB that started this whole circus, by calling for the new H5N1 publications to be partially censored. In the open letter, the virologists argue that this censorship is unjustifiably hindering scientific progress. They were apparently too polite to say that deliberately omitting data from a publication in response to a nebulous, entirely theoretical “security risk” is antithetical to the whole scientific enterprise, so I’ll do it for them.
The moratorium should help bolster public confidence in the scientists’ ability to address this issue themselves, while the letter to the NSABB lays the groundwork for a productive debate based on reason rather than fear. Hopefully, in a couple of months everyone will be able to calm down and get back to work.
I was revving up to post a long rant about the censorship of a new paper on H5N1 influenza, but my friend and TWiV co-host Vincent Racaniello beat me to it. I do, however, have a couple of things to add.
If you’re just tuning in, the short version goes like this: some researchers claim to have isolated a novel strain of H5N1 “bird flu” that is highly transmissible in ferrets, the standard animal model for human flu infection. This triggered a huge round of hand-wringing by various quasi-official groups, claiming that this information could allow some imaginary “bioterrorist” to create The Plague of The Apocalypse. Or words to that effect. Today, the authors of the study announced that they would redact some of the data from the paper to prevent that from happening.
But as Vincent explains in his post:
The article hints that details of the experiments may be made available to influenza virologists ‘with a legitimate interest in knowing them’. Who will decide what constitutes a legitimate interest? And what if a virologist, or another scientist who does not work on influenza virus, has an idea for an experiment and would like the details? Will they be denied because they are not card-carrying influenza virologists? Science often works in unusual ways, and one of them is that difficult problems are often solved by individuals from different areas of research.
In addition, the data have already passed through dozens, perhaps hundreds of hands. There are the folks in the lab who did the work, any collaborators they worked with, the peer reviewers for the papers, anyone at Science and Nature who handled the manuscripts, and of course the sysadmins for every email server connecting all of those geographically distant points. Most scientists don’t have the first clue about information security, so any terrorist who actually wanted these experimental details could probably get them. The only people who won’t have easy access to the data are precisely the folks we want working on this problem.
But why would the terrorists even bother? What the paper shows (allegedly – it still hasn’t been published) is that H5N1 can become contagious in ferrets while retaining its virulence. That certainly could be bad news for weasels who spend a lot of time around poultry farms, but it’s not at all clear what it means for the rest of us. While ferrets are probably the best animal model we have for studying influenza infection, that’s not saying much. Their track record on predicting virulence is particularly spotty; H1N1 “swine flu” is terribly deadly to ferrets, but actually less lethal in humans than most regular seasonal flu strains. There have been quite a few human cases of H5N1 already, so whatever adapting the virus can do in us, it’s already had lots of chances. We’re not dead yet.
If I were a terrorist, I certainly wouldn’t waste my time following up such a weak lead, particularly since there are so many easier, cheaper, more reliable ways to cause terror. How about 1918 flu? It’s unquestionably deadly to humans, and the full sequence – unredacted – came out in 2005. Or anthrax? Or SARS? Nature abounds with nasty microbes.
But why bother with these fickle biological agents at all? Explosives aren’t nearly as hard to work with, and from the headlines it looks as if they continue to serve terrorists’ needs quite well. Finally, let’s remember that most of the official paranoia of the past decade was brought to us by a small group of guys armed with nothing but box cutters, basic flight training, and hatred. How are we going to redact that?
Today’s New York Times brings a sobering story:
A 2-year-old boy spent seven weeks in the hospital and nearly died from a viral infection he got from the smallpox vaccination his father received before shipping out to Iraq, according to a government report and the doctors who treated him.
The boy, who lives in Indiana and has recovered, became ill in early March, two weeks after his father’s deployment was delayed and he was allowed to make a trip home. Over the next few weeks, the boy suffered kidney failure and lost most of his skin to the disease, eczema vaccinatum.
By my count, “bioterrorism” has killed somewhere around six Americans. How many have been killed and maimed by the multi-billion-dollar-and-mushrooming “biodefense” response?