Winning the battle against emerging pathogens

Abstract

Technological advances in the life sciences hold out the promise of controlling or eliminating stubborn diseases. They also increase the risk that malevolent actors will learn to produce new and highly dangerous pathogens, a prospect that deeply concerns security professionals in developed countries. In the developing world, meanwhile, where many nations struggle mightily with diseases such as AIDS and malaria, public health concerns tend to focus more on the here and now—or, when it comes to emerging threats, on how to contend with natural rather than human-made pathogens. Authors from four countries—Oyewale Tomori of Nigeria (2014), Louise Bezuidenhout and Chandre Gould of South Africa, Maria José Espona of Argentina (2014), and Iris Hunger of Germany (2014)—explore how governments, institutions, and professionals in both the developed and developing worlds can make the world safer from emerging pathogens, whether natural or human-made.

Scientists often find themselves enthusiastically embraced as a first line of defense by those who care about reducing the risk that research and experimentation will be misused for harm, or that harm will arise from laboratory accidents. But serious questions surround ethics education for scientists and associated standards for responsibility, professionalism, and good conduct. Ethics education, for example, often fails to prepare scientists to meet the expectations that are placed on them and to assess the potential social harm of research. And studies indicate that ethics education, on a global level, remains patchy and unstandardized (National Research Council, 2010). Until ethics education on an international level becomes more comprehensive, it is difficult to see how scientists can be cast with real confidence as first-line defenders.

Ethics education for scientists needs to be focused in such a way that scientists perceive value in the topics under discussion—that is, ethics education requires buy-in from the scientists themselves. Without it, ethics education can aspire to little more than providing scientists with information about the risks associated with biosafety, biosecurity, and dual-use issues. It will not encourage scientists to engage in critical reflection about the misuse of research and to practice ethical decision making. (“Biosafety,” in simple terms, refers to preventing unintentional exposure to pathogens, or their unintentional release. “Biosecurity” means protecting pathogens from theft, loss, or diversion. “Dual-use” research is legitimate research that could be misused to threaten public health or national security.)

Getting buy-in from scientists is not difficult where biosafety is concerned. The biosafety risks associated with research, and scientists’ responsibility to address these risks, are a fairly straightforward and generally manageable element of the training curriculum. But making scientists properly aware of security risks—whether these risks fall into the biosecurity or the dual-use category—is a far more complicated process. Scientists often perceive these risks as quite removed from their daily research practices. If scientists are presented with responsibility for reducing risks that they perceive as unfounded, the efficacy of measures to reduce these risks can be severely undermined. Thus ethics education must walk a fine line—encouraging critical reflection and ethical decision making without exaggerating the security risks inherent in research.

Low- and middle-income countries often suffer from a persistent lack of formalized ethics education. The majority of the ethics education that scientists receive in these contexts becomes available because funding arrangements or collaboration agreements require that it be provided (or else it comes in the form of online courses). Scientists therefore receive ethics education that is highly generalized—or, if specific, is specific to the research context of a high-income country. These decontextualized ethics initiatives often discuss types of research that are outside the national research remit of low- or middle-income countries—and scientists often struggle to see the point in discussing risks that fall outside their frames of reference (Bezuidenhout, 2013). And in low- or middle-income countries, highly visible problems such as poor health care provision may overshadow security concerns, increasing security’s apparent irrelevance to the work of scientists.

Many countries, including low- and middle-income countries, lack comprehensive structures that allow scientists to report concerns about biosafety, biosecurity, and dual-use issues. It is likely that many countries will continue to lack these structures for some time. So those involved in ethics education should be careful not to present scientists with responsibilities that they have no means of fulfilling. Initiatives in ethics education must strike the right balance between responsibility and risk; otherwise, scientists will see biosecurity and dual-use issues as simply not pertinent to their research.

Not getting fixed

Until problems such as unstandardized ethics education are overcome, it will be very difficult to establish an international community of scientists who can truly act as a united first line of defense against emerging pathogens. But these problems have been discussed for years in the context of the Biological and Toxin Weapons Convention (BTWC). Likewise, problems in the global health system, such as low national health capacities and shortcomings in disease surveillance and response, have received considerable attention in international health discussions (particularly discussions surrounding the BTWC and the World Health Organization). But the problems remain. If shortcomings in ethics education, national capacity, and disease surveillance are so well understood, what stops them from being addressed successfully?

The likely answer is that these shortcomings are symptoms of larger problems in the global health system. One such problem is weak or corrupt governance. Another is the relatively low priority given to public health at the regional, national, and international levels. But another is the BTWC itself. The treaty, while it has the potential to provide a framework for international cooperation and exchanges in health, is undermined by its current inertia—which can be traced to the 2001 collapse of negotiations to establish a verification mechanism for the treaty. The BTWC, like other disarmament treaties, is also vulnerable to larger international political tensions. Today, decision-making processes in the treaty context are all but nonexistent.

In 2011, ahead of the Seventh Review Conference for the treaty, co-author Gould, along with Jeremy Littlewood and Gigi Kwik Gronvall (BioWeapons Prevention Project, 2011), argued that one way to cure the BTWC’s malaise might be to more vigorously implement the treaty’s Article X, which encourages states to share knowledge and technologies. Such sharing could, among other things, improve disease detection and response. Gould, Littlewood, and Gronvall recommended—and this remains as relevant today as it was in 2011—that knowledge and technology exchanges between developed and developing nations no longer be cast as interactions between donors and hapless recipients.

When it comes to disease surveillance and response, developing countries can give as much as they gain in exchanges with wealthier nations. But as things stand now, developing countries don’t view the BTWC as a useful forum through which to raise concerns and share knowledge. This produces something of a chicken-or-egg problem, because if the treaty is to become truly relevant to scientists and publics in emerging countries—and more effective on a global level—developing nations need to put their own stamp on proceedings. Discussions at the BTWC that do not take into account the concerns of developing countries produce linguistic and conceptual gaps that ultimately induce apathy. This problem must be overcome if all parties to the treaty are to participate in it effectively.

Unfortunately, there are only a tiny handful of civil society groupings around the world that follow the proceedings of the BTWC. A similarly insignificant number of national activist organizations campaign for improved public health services. So while the treaty could offer a powerful tool for fostering international discourse on disease control, something is lacking—the political pressure and sense of purpose needed to effect changes that could counter the spread of disease.