The recent meeting of the National Science Advisory Board on Biosecurity this month was a public event to consider the status of gain-of function experiments with highly pathogenic avian influenza H5N1 (HPAI). Such experiments were the basis of two controversial papers published earlier this year that elevated concerns over whether scientific research carried the danger of producing dangerous viruses that posed threats to human health. The meeting considered biosafety issues as well as the new NIH research funding framework. The development of a more stringent review process for NIH funding of such research is underway; public comments on the proposed policy are invited until January 10, 2013. Reports from the meeting indicate an emerging consensus from the participants that the current voluntary moratorium on HPAI research should be ended. Separately, the comment period to respond to the CDC’s question of whether HPAI viruses should now be included in the most stringent class of biological agents, Tier 1, has been extended to January 13, 2013.
A recent review paper by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and colleagues looks at 20 years of emerging infectious diseases (EID). The concept of EID was elevated into prominence with the publication of an Institute of Medicine report in 1991 that considered EID as threats to U.S. health. The 20 year period since encompasses the AIDS and SARS pandemics, although the AIDS crisis began in the 1980’s. Both are viral diseases, and the difficulty in designing effective treatment regimens underscores the fears associated with a possible emergence of pandemic influenza. The concept of EID as a critical focus of public health research and surveillance is well-established, and the SARS pandemic in 2003 illustrated not only the obvious scientific challenges, but how international cooperation (e.g., data-sharing) was essential to tracking outbreaks. Another recent paper in PLOS Medicine analyzes pandemic preparation with reference to lessons learned from SARS and other international public health crises, noting that although pandemics will appear in the developed countries because of global travel, etc., the likelihood of initial pathogen emergence in less-developed countries means that public health infrastructure remains a general gatekeeper to the world's overall health. The authors caution that disease-specific programs (e.g., AIDS-specific, vertical) can shift focus and resources from baseline public health maintenance in a manner that facilitates the development of pandemic outbreaks. In an effort to locate the “proximate driver implicated in each outbreak” the authors find that the most significant predicate is the “breakdown of public health measures includes inadequate sanitation and hygiene, e.g., the shortage of potable water, poor immunization coverage or the lack of infrastructure to purchase and deliver vaccine, and the deterioration of vector-borne and zoonotic disease control.” Thus, pandemic preparedness relies on a combination of high-tech and low-tech measures; determining the genome sequence of an emerging virus is routine today, but such a technical achievement does not supplant the need for investment in the low-tech infrastructure that helps to limit the spread of any emerging pathogen.