Thursday, January 26, 2012

Flu the coop

H5N1, better known as “bird flu,” doesn’t have a rep as a devastating pathogen. More Stanley Goodspeed than John Mason, it has occupied the same dusty corner of my mind as SARS, swine flu, and every other coulda been shoulda been superbug that was a bigger bust than Darko.

Despite on again off again concerns of epidemics in Southeast Asia and other parts of the world, the disease, which has proven exceptionally good at killing people (mortality >50 percent), doesn’t make the jump from birds to humans all that well. So even if the survival rate for people who catch the disease isn’t good, there aren’t many people who catch the disease. Moreover, experts had predicted that any mutations necessary for the disease to become more contagious would also result in the disease becoming less deadly.

Given all this, H5N1 is still a concern. The virus is endemic in many parts of Southeast Asia – meaning that it is constantly present in feral flocks of fowl, and therefore practically impossible to eradicate the way scientists attacked Smallpox in the 70’s.* For food production as well as public health, H5N1 remains an important subject of ongoing research.

*More on this in a post to come.

Two of those efforts – both funded by the US’s National Institute of Health – investigated what changes would be necessary for virus to become contagious among humans. Using ferrets as models,* the scientists discovered that the necessary mutations were not all that significant – only five in total. Even more troubling, in one case, the changes that allowed the virus to become more contagious did not seem to lower the fatality rate (again, in ferrets). So now that the scientists finished their study, they set out to do what they were trained to do: publish!

*I know what you’re thinking. Ferrets? Well yes, yes, and yes. They are (apparently) a commonly used non-rodent mammalian flu model.

Of course, their findings went to top level journals (Nature and Science), but in December, the US National Science Advisory Board for Biosecurity caused quite a stir when they recommended that certain parts of the methods sections of the two manuscripts be withheld from the public and only shared with vetted, qualified scientists.* 

*Just who would do the vetting and how is still being fleshed out. The NSABB is a purely advisory board that wouldn’t have any real power to administer such a program. They are working with journals like Nature and Science, as well as other government agencies to put something together as we blog.

Scientists from across the globe weighed in on all sides of the issue. Some bashed the decision arguing, “don’t censor life-saving science,” or just generally disagreeing with the NSABB’s recommendations. Others have called the mutated virus “the ultimate biological threat.” The rest filled in all points between. For the time being, however, the leading researchers in the field (38 in all) have agreed to a self-imposed 60 moratorium on further experiments.

So, given all this, what do we do now? Well, the papers have not been published and the journals are meeting with government officials and other experts to determine what such a system of privileged access would look like. The natural persistence of the unmutated stain of H5N1 makes the continued study of the virus imperative, but the dangers of these new mutated strains cannot be ignored. Therefore the question is not if we move forward, but how? Here are four things for the scientific community everyone to keep in mind as we moves forward:

Why can’t we just kill all the birds?

This is an import point. If the birds are the ones infecting humans, why can’t we just get rid of the birds? Hong Kong actually did this after a 1997 outbreak, killing every fowl within its borders. But now that cases of H5N1 have been reported from Egypt to Indonesia and the virus circulates permanently in wild bird populations of many countries, such an undertaking would not only be a logistical nightmare, but ecologically and economically destructive on a massive scale. However, it does bring up the important point that many of the regions affected by H5N1 have lifestyles which lend themselves to frequent and close contact with live fowl. Changing that may be a good first step.

The review system is not broken

Every scientific paper is reviewed by fellow experts in the field. In this case, the peer review system caught the dual use issues (science that can be used for good…or evil) associated with this research and passed the papers along the appropriate authorities. The problem was those authorities didn’t have any system in place for dealing with research like this.

Need for an international system

Scientists should not fully disclose the recipe for making a pathogen so dangerous. Nevertheless, this information is important to global health and should be shared with competent, qualified researchers around the world.  Even though no such system is in place, this isn’t the first time the world has had to figure out how to distribute and regulate massively destructive information. The International Atomic Energy Agency serves that purpose for nuclear power; a similar organization could oversee life science research involving potentially catastrophic pathogens. Ideally something could be set up through the World Health Organization. However, any system would need to establish what safety precautions researchers on these mutated H5N1 strains would need to take.

This is a big deal

There are different levels of Bio Safety (called BioSafety Levels or BSL’s). Level one is basically “digging up worms in the back yard to go fishing” and level four is “E.T. The Extra Terrestrial” or The Stand type stuff. Up until now H5N1 has been classified as level 3+. Some argue the mutated strain should remain at there so that more people are able to study it (and we can figure our ways to stop it more quickly).

However, this is serious stuff. As a comparison, SARS, a level three pathogen, has had an escape rate of 1% (3 times in 300 lab years) over the past 8 eight years.

That’s not terrible, but it’s also not acceptable either. If only one thing comes out of this process it should be that these mutated strains are treated as BSL-4 agents until we can show cause for them to be designated otherwise (it already looks like the Kawaoka Group's version can be stopped with current vaccines and antivirals). This is serious stuff, and even though I bashed him earlier, the only people I trust working on this are the Stanley Goodspeeds of the world. Carla was the prom queen after all.

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