H5N1 flu virus public domain 1920 x 1583

It would have been easy to phrase the title of this post by paraphrasing Shakespeare’s original “that is the question,” but the issue at hand is much more fateful, even existential, than a mere question; it is indeed a dilemma.

 

Avian flu, or H5N1 virus

A 39-year-old bus driver in China died from multi-organ failure on Saturday, New year’s eve 2011, as a result of infection by a virus that authorities recently confirmed to be related to the H5N1 bird flu. The case, the country’s first in 18 months, led to fears that the virus may spread.  But according to the Shenzhen Disease Control Center, a genetic analysis indicated the virus spread directly from poultry to the victim and is not contagious among people.

“The virus found in the patient was 90 percent similar to H5N1 viruses previously isolated in ducks in China, which suggested that the man was very likely to have been infected through direct contact with a bird,” the agency said in a statement. ”Though it is highly pathogenic to human beings, the virus can not spread among people.”

How many of us paid any attention to this news item? I didn’t. I was celebrating the arrival of the New Year in Cartagena, Colombia, and couldn’t care less about the bird flu episode in China.

But consider the statistics: According to the World Health Organization, there have been only 573 confirmed bird flu cases since 2003, 336 of which were fatal. Do the math: that is a 58% mortality rate!

 

What happens is the virus mutates?

The avian flu is endemic to birds, both domestic geese, ducks, chickens, and wild birds. The disease is rarely, if ever, fatal to birds. But a contact with humans is likely to be deadly. Reason? we don’t have immunity to the virus, whereas the birds do. Why didn’t we develop immunity to this virus? Because the virus cannot be transmitted from human to human. So the epidemic dies out with the demise of the victim and no chance for immunity to develop. Can the virus jump from one human to another? not until it develops mutations that would facilitate such a transmission.

Such a mutation can occur and probably will occur, given enough time. Mutations occur all the time, and at a tremendous rate. The vast majority die out because the right conditions for their survival are not present. But the rare circumstance of a mutation that facilitates human-to-human transmission and simultaneously has contact with a human is bound to occur, and voilá -an epidemic is born.

The consequences of such an event are pretty serious. Example: the virus known today as SIV, or Simian Immunodeficiency Virus, lived in monkeys and apes for thousands of years. Occasional contacts with humans probably occurred over time, but ended up in the death of the infected person without transmission of the virus to other humans. But then a mutation occurred that allowed transmission between humans and thus morphed SIV into HIV, with devastating consequences. Wouldn’t you consider then that it is imperative to study the process of conversion of exotic animal infections into human pathogens?

 

Indeed, a research group succeeded in making avian influenza (H5N1) highly contagious in the lab. The researchers, led by virologist Ron Fouchier of the Erasmus Medical Center in the Netherlands, induced five mutations that rendered the virus highly contagious among ferrets; these animals mimic faithfully the influenza pathology as it occurs in humans. They presented their findings in September of 2011 at the European Scientific Working group on Influenza conference held in Malta, and two manuscripts of the research were sent, one each, to Science and Nature.

A U.S. government biosecurity advisory panel recommended that the two manuscripts describing mutations in the H5N1 virus that make it more transmissible between mammals be published in incomplete forms. In essence, the US National Science Advisory Board (NSABB) made the recommendation because the research, if published in its entirety, would contain detailed information that could put dangerous strains of bird flu into the hands of terrorists.

“Because the NSABB found that there was significant potential for harm in fully publishing these results and that the harm exceeded the benefits of publication, we, therefore, recommended that the work not be fully communicated in an open forum,” more than 20 NSABB members wrote in a comment published in both Nature and Science.

Science and Nature jointly published a letter on January 20, 2012, declaring a voluntary 2-month suspension of research into transmission of H5N1 highly pathogenic avian influenza. The letter, signed by 39 influenza researchers around the world, acknowledges that before research continues, there should be informed, global discussions regarding its regulation and publication.

Not surprisingly, two camps espousing two diametrically opposed positions dominated the debate. On one side are the “national security” advocates who want to ban all publication of research that is potentially dangerous.

The argument that such research should be conducted but not published stems from the chance, however remote, that groups with malicious intent could deduce how to make a deadly biological weapon. Many countries have biological weapons programs, for example, which are developing deadly pathogens. When the Soviet Union collapsed, Sergei Popov, one of the heads of the country’s genetic weapons program defected. While being debriefed Popov revealed that the Soviet Union had active programs to weaponize Legionnaire’s disease, Ebola, smallpox, and HIV.

And now, with biotechnology continuing to advance, even a small, but determined terrorist group or an apocalyptic cult could conceivably generate a weaponized pathogen that was capable of doing great damage.

The suggestion that the papers should be published in a redacted form, omitting critical details that are essential for replication of the procedures is a non-starter, according to some security experts. In this age of WikiLeaks and hacking nothing can be kept secret anymore.

Joining them are people who argue that such dangerous research is unethical – what if some virus particles escape the laboratory? All research on dangerous organisms should be banned outright, they argue.

On the other side of the barricade are the scientific purists who argue that nothing justifies muzzling the free flow of scientific information. Their argument is that without complete knowledge of the procedures employed in the papers legitimate scientists won’t be able to do research on ways to protect us from a virulent strain of a new pathogen. The likelihood of a pandemic-causing mutation is much higher than the possibility of a terrorist group weaponizing the organism, they argue.

 

So what to do?

I don’t think there is an easy answer; both sides have legitimate concerns and persuasive arguments to back them up. The world we live in quite dangerous, but not only because of terrorists but also because of human expansion into habitats of animals carrying exotic pathogens against which we are utterly defenseless. The 1918 flu epidemic wiped out one-third of the European population, and that virus was not as dangerous as Ebola or H5N1.

It may be a cop-out, but the middle way sounds to me most reasonable. The research has to be done because the danger of exotic infections acquiring mutations that allow rapid transmission among humans is clear and present. The risk of bad actors using this information to inflict harm is just as likely. The solution may lie in the formation of a committee, possibly under the U.N. auspices, and composed of scientists and national security experts that would vet who would be authorized to conduct such research, monitor the safety precautions to be followed, and take possession of critical data.

Such an arrangement is unprecedented, but extraordinary circumstances demand extraordinary measures. This is no time for ideological purity on either side.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.

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