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 (2014), Maria José Espona of Argentina (2014), and Iris Hunger of Germany—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.

For nearly two decades, experts have been highly concerned about the security implications of technological advances in the life sciences, in particular the effect of these advances on the likelihood and severity of bioterrorist attacks. In the mid-1990s, a white supremacist with an interest in biological weapons ordered plague bacteria from the American Type Culture Collection—which was perfectly legal at the time—demonstrating how easy it was to obtain dangerous pathogens in the United States (Stern, 2000). In 1997, Secretary of Defense William Cohen appeared on television holding a sugar bag, stating that an equivalent amount of anthrax could devastate Washington, DC. After the 2001 anthrax attacks in the United States, which led to the deaths of five people who had been exposed to anthrax contained in letters (Jernigan et al., 2002), threat perceptions surrounding bioterrorism increased dramatically, and politicians asserted that a major bioterrorist attack was not a question of “if” but “when.” Such an attack, it was suggested, would be a mass casualty event, with tens of thousands of people sickened and killed.

Fortunately, almost nothing in these predictions has come true. To the extent that extremist or terrorist groups have displayed interest in biological agents, it has been on a very basic level, mostly involving easy-to-handle substances such as the plant toxin ricin. Nonetheless, (mostly Western) countries have spent billions of dollars over the last decade or so preparing for a bioterrorist attack, stockpiling vaccines and antibiotics, developing response plans, conducting table-top and simulation exercises, and installing systems for monitoring. Comparatively little has been spent on prevention measures such as improving the physical security of laboratories that deal with risky pathogens and educating scientists about the misuse potential of life sciences work. On the international level, nations have agreed to very little that would counter the threat of bioweapons, whether those threats are posed by state programs or non-state actors.

Three steps

Bioterrorism, fortunately, has remained a largely hypothetical threat so far. But the burden of naturally occurring diseases continues to be heavy. A glaring disproportionality characterizes the resources available to counter bioterrorism and naturally occurring diseases. For example, an estimated 1.3 million people worldwide died from tuberculosis in 2012, and funding for tuberculosis control in low- and middle-income countries amounted to $6.1 billion in 2013 (World Health Organization, 2013). Meanwhile, five people have been killed in bioterrorist attacks since 1900 (Leitenberg, 2005; Tucker, 2000), but biodefense spending in the United States grew from $576 million in 2001 to more than $8 billion in 2005, with $6.7 billion budgeted for 2014 (Franco and Deitch, 2007; Sell and Watson, 2013).

It is important that health expenditures be allocated in ways that benefit public health most. It’s also important to reduce the risk that life science technologies will be misused for bioweapons purposes and to limit the devastation that bioweapons would cause if in fact they were used on a large scale. I believe that these imperatives could best be served if specific measures were taken to establish international oversight of certain life-science activities; to increase awareness among scientists; and to strengthen health systems.

First, the small number of activities in the life sciences that are prone to direct misuse for weapons development should come under international oversight. In the nuclear arena, enrichment can be prohibited or at least closely monitored; the same is true of work with sulfur mustards in the chemical arena. Nothing like this has been agreed upon in the biological area.

Everyone understands the “dual-use dilemma”—the reality that certain techniques, data, information, and implicit and explicit knowledge (though they are developed, generated, and disseminated for the benefit of public health) could be misused for biowarfare or bioterrorism. But though governmental and nongovernmental experts have produced dozens of lists of “dangerous” activities or “dangerous” agents, none is generally accepted on an international level as guidance for control efforts. Nor are the control measures themselves, such as regular international project reviews or international on-site inspections, generally accepted. An urgent task for parties to the Biological and Toxin Weapons Convention is to develop and update a list of activities that ought to be conducted under international scrutiny. Likewise, it is urgent that parties to the treaty agree on procedures for international oversight. Such oversight is no unattainable fantasy—as illustrated by the international oversight procedures that have been established for smallpox research.

Second, all life scientists need to become aware of the dual-use nature of their work and of the steps they can take at an institutional level if they suspect misuse. Only a small subset of life science activities can be put to direct use in efforts to develop bioweapons, but many life sciences activities, such as studies on pathogenicity or drug resistance, can support such efforts indirectly. Thus, awareness-raising about biosecurity should be integrated into standard bioethics education. Scientific associations and academies of science would be appropriate coordinators for awareness-raising—in fact, some such groups have already been active in this regard over the past decade.

Third, establishing stronger public health systems can prevent disease outbreaks, or limit their effects, whether the outbreaks are naturally occurring or are due to malevolent releases of pathogens. Indeed, from a public health perspective, the risk that pathogens will be released intentionally has simply joined a list of existing, but constantly changing, natural threats.

To be sure, the differences between naturally occurring and intentional disease outbreaks are significant. The impacts of naturally occurring infectious diseases are to a certain degree foreseeable, and health care professionals have gained great experience in preventing, limiting, countering, responding to, and recovering from them—while bioterrorism events have been so rare that knowledge about them is almost exclusively hypothetical. Likewise, natural and intentional outbreaks will differ regarding the types of diseases involved, the extent of decontamination necessary, and the legal ramifications. But in certain significant areas, the differences are likely to be small. These areas include detection (for example, through disease surveillance) and public health response measures that are not disease-specific (such as finding and interviewing patients, finding and eliminating the source, and instituting quarantine and hygiene precautions). After all, a disease outbreak is a disease outbreak, no matter how it starts. Strengthening public health systems globally would improve the health of people around the world, and would have the added benefit of increasing preparedness in the unlikely event of a bioterrorist attack. In developing countries in particular, such an approach would make a great contribution to human development, both for individuals and for societies.