The Man-made H5N1 Controversy Heats Up: What Next? (Part One)

Posted on by Laurie Garrett

Tomorrow 22 scientists will gather in Geneva at the World Health Organization to decide the fate of man-made flu viruses, including whether details regarding how the dangerous strains of H5N1 were made. The viruses – at least one form made by Dutch scientists – may constitute the most dangerous microbes our species has ever confronted, combining both the potential to spread rapidly from human-to-human, and the highest virulenceever seen with influenza.

This is the first of a daily series of blog postings over the next week that will dwell on issues surrounding the H5N1 controversy.

I cannot recall any debate within the Life Sciences that has spawned as significant a volume of publication and emotional pitch of debate as has the manmade H5N1. More than 100 opinion pieces, blogs and journal pieceshave appeared in the scientific literature since October 2011, laying out arguments for a vast array of positionson what steps should, or should not, be taken in response to Ron Fouchier’s Erasmus University experiment. An additional volume of material has appeared in general media and the general blogosphere, with Facebook and Twitter cluttered with commentary running the gamut from cogent debate to conspiracy theories and declarations of doom or anger. One comment in response to a New Zealand posting reads, “Damned Yanks will be the end of us all. With the threat of another war in the Middle East, this time they're getting Israel to do their dirty work, and now this. What future do we have.”

Interestingly, all these writings have appeared without publication of either Fouchier’s research, or that of University of Wisconsin H5N1 expert Yoshi Kawaoka. Since December, when the National Scientific Advisory Board on Biosecurity (NSABBasked that Science and Nature censor the “how-to” materials and methods sections of the relevant papers, both journals have held off publication. Flu researchers declared a voluntary60-day moratorium on H5N1 work, also pending some mythological consensus decision regarding how best to simultaneously encourage flu research while preventing accidental or deliberate release of the deadliest organism ever manufactured, and probably the worst ever to arise, either naturally or in a lab, in terms of potential consequences for mankind.

The February 2 debate at the New York Academy of Sciences offered a window on both the divergence of opinions among scientists – which appears to be growing wider with time – and the near-absence of input from those outside the scientific community.

There are several concerns, from both foreign policy and national security points of view.

Today’s concern: 1. The World Versus a Handful of Scientists

On February 16-17 the WHO will convene a closed-door meeting of twenty-two invited scientists, aimed at hammering out a policy that can allow H5N1 research to move forward, protect the UN agency from related disputes that have haunted World Health Assemblies for years, and ensure that deadly flu strains never escape to cause a pandemic. According to WHO spokesperson Christy Feig, the focus of this gathering will be whether or not details regarding how the Fouchier and Kawaoka experiments were performed should be published. "In this first meeting, we've got to sort out the deadlock, I think, that we're in with the scientific community. I don't think anyone anticipates that to happen very quickly," Feig told the Winnipeg Free Press. In the room with the WHO personnel will be Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, Dr. Paul Keim, head of the NSABB, Kawaoka and Fouchier, an unknown list of additional scientists, and representatives of Indonesia and Vietnam. The later will be present because Fouchier based his work on an Indonesian strain of bird flu, while Kawaoka obtained his sample from Vietnam.

In May 2011, the World Health Assembly of the WHO approved the Pandemic Influenza Preparedness (PIP) Framework, hammered out after six years of extremely difficult and complicated debate, during which time the Indonesian government declined to share H5N1 samples with the WHO or the scientific community in general. The few viral genomes released publicly were fragmentary. Indonesia argued in 2006 that under principles of what its then-Minister of Health Siti Fadilah Supari dubbed “viral sovereignty,” the country could declare microbes found on its soil to be the property of the state, not to be shared with outsiders. Supari laid out her position in a 2007 book, Saatnya Dunia Berubah: Tangan Tuhan di Balik Virus Flu Burung, in which she described with pride her confrontations with the U.S. government, and alliances made with Iranian President Mahmoud Ahmadinejad. She declared H5N1 a “gift from God” that was teaching the Islamic world about global injustice. Following the 2009 reelection of President Susilo Bambang Yudhoyono, Supari was dropped from the cabinet and replaced with Endang Rahayu Sedyaningsih, a graduate of the Harvard School of Public Health.

Despite Supari’s departure, Indonesia remains particularly concerned that for-profit companies do not have access to national viral samples without guarantees that said companies make both products produced based on the viruses, and profits derived from those products, available to Indonesia. The Indonesian position put international trade and intellectual property issues squarely alongside pandemic preparedness, igniting a debate that raged across international public health and disease prevention.

Indonesia has led the world in human H5N1 cases and deaths since 2006, with a mortality rate of more than 85 percent in identified human cases. Scientists have been eager to learn why Indonesia has such a severe bird flu problem, and ensure that the strains circulating in that country do not have uniquely dangerous genetic traits.

As the debate has unfolded, Indonesians have watched Westerners haggle, wondering when their voice might get heard. The Jakarta Globe ran a January 25 piece that essentially declared victory for the country’s position, based on statements made by Ron Fouchier.

Dutch scientist Fouchier hit a positive nerve in Indonesia when he published his opinion, arguing that the H5N1 research should be published in full, with no methods redacted. "We don't know the worldwide opinion until a group of experts from all parts of the globe is formed. An issue this big should not be decided by one country, but by all of us," Fouchier wrote. “As researchers, we work very closely with people in Indonesia. It would be very unwise for us not to share our results with our close collaborators.”

The Globe praised the Dutch scientist for demanding the right to publish his work in full. “Borrowing a phrase from Siti Fadilah, the time is more than ripe for the world to (once again) change,” the Globe concluded. “Since the United States is the one country that strongly opposed Indonesia’s decision to withhold virus samples in 2006, it should be easy for Washington to understand why it is crucial that the results of the Erasmus-Wisconsin research are shared with the global community of scientists.”

The WHO is in a tough position. It must find a way to guarantee free and open sharing of H5N1 related information, genetic sequences, and viruses, while also guaranteeing public health safety. The agency has chosen to debate the issue in private, among twenty-two scientists, nearly all of them funded by the U.S. National Institutes of Health (NIH) or counterpart agencies in Western Europe. Inclusion of Vietnamese and Indonesian scientists cannot by any stretch equate with worldwide debate.

Tomorrow’s Blog: Is Censorship, as a Practical Matter, a Meaningful Deterent to Malevolent Use?