June 6, 2014

Eve of Destruction? World Health Organization Defers Setting Date for Destruction of Smallpox Virus

The public health campaign to eradicate smallpox, a highly contagious viral disease with significant mortality, was one of the public health success stories of the 20th century. Following decades of vaccination against the variola major virus, the causative agent of smallpox, the World Health Organization (WHO) declared the eradication of smallpox in 1980 (the last case in the U.S. occurred in 1949, and the last global case was in Somalia in 1977). With this goal achieved, a long-standing concern for international public health authorities has been how to limit and manage the remaining stocks of the smallpox virus. With eradication achieved, should variola virus be retained in laboratories, in view of its characterization as a dual-use microbe – a source of legitimate research interest as a viral pathogen as well as a potential bioweapon? In 1983, by international agreement, a decision was made to retain variola virus stocks at two WHO Collaborating Center laboratories: the State Research Centre for Virology and Biotechnology in Koltsovo, Russia, and in the U.S. at the Centers for Disease Control and Prevention in Atlanta, Georgia. Speculation has continued, however, over whether unaccounted virus stocks exist in other places. The World Health Assembly (WHA), the decision-making conference of the WHO, supported the policy of setting limits on access to variola virus, and, by 1994, endorsed the eventual destruction of the remaining virus stocks. Over the years, WHO surveyed whether consensus research goals required continued maintenance of virus stocks. In 2011, the WHA reaffirmed the eventual destruction of the virus stocks, but deferred the setting of an actual date to the WHA conference in May of this year. Within WHO, the two advisory committees that considered the issue reached different conclusions. At this recent conference, it was decided that the virus stocks will continue to be maintained, because research goals dependent on access to the virus remain unfinished. These goals include the further development of antivirals (smallpox vaccines exist and are maintained in national and international stockpiles). Dissension among the WHO advisory committees contributed to the decision to delay the setting of a date for destruction of the stocks. Not surprisingly, a divergence of views on the merits of retaining variola virus stocks exists in the scientific community (support for maintaining virus stocks for future research versus calls for destroying the virus stocks) as well as among the WHO member states (with U.S. favoring retention while less-developed countries have favored destruction). A further wrinkle in the debate is the emergence of new technical capabilities (e.g., synthetic biology techniques) that could allow artificial reconstruction of the smallpox genome; such a possibility focuses policy concerns away from access to viral stocks and instead on access to genomic and technical information (actual publication). Of course, concerns about informational access have surfaced recently with research reporting the development of highly pathogenic H5N1 influenza viruses (see here and here). The still-unresolved smallpox (variola) virus retention issue illustrates how dual-use research concerns can originate from existing natural pathogens, as well as newly engineered or synthesized pathogens.

No comments: