Publish and be damned? Sussex debates the bird flu research controversy

Professor Stefan Elbe

Research into the H5N1 virus (avian, or bird, flu) published at the start of May showed how the virus can be mutated in a laboratory to create a contagious form that can infect and be passed to and from mammals. Previously, the cause of bird flu infection in humans was traced to very close contact with infected birds; this research shows how close it could be to evolving into a form that could be spread directly from human to human.

Publication of the study by the virologist Yoshiro Kawaoka of the University of Wisconsin in the science journal Nature, and that of a separate study on H5N1 mutation, still awaiting publication in the journal Science (by Ron Fouchier of Erasmus University in the Netherlands) were first delayed last year following a controversy that the methodology and findings of both research projects might put humans at risk if used, for example, by bioterrorists.

Both scientists had publication postponed and their papers censored as a result of the ethical and security concerns raised, and both were embroiled in wrangles that involved having their work censored and subject to government interference. But both research projects could also do much to inform science’s understanding of the evolution of such viruses and allow development of vaccines to prevent devastating epidemics.

So how do we balance the competing pressures of research value and risk, and just what right do governments have in censoring and controlling the publication of new science?

Here, Stefan Elbe, Professor of International Relations and Director of the Centre for Global Health Policy in the School of Global Studies, examines some of the key issues from the debate.

Q What are the controversies surrounding research into the avian flu virus (H5N1)?

A There are actually three controversies rolled into one:

• According to the World Health Organisation (WHO), H5N1 kills around 60 per cent of people who become infected with the virus. So the decision by scientists to conduct experiments making such a deadly virus transmit MORE easily between human beings is controversial.
• The knowledge that has been generated could be dangerous, especially if it falls into the wrong hands (e.g. bioterrorism). But does this mean that the USA’s National Science Advisory Board for Biosecurity (as in the cases of Kawaoka and Fouchier) has the right to demand that parts of the research are censored prior to publication?
• There are strong pro-security arguments that this research is too dangerous to be made public in all its detail. There are also strong pro-science views that say the research is important for public health. High profile organisations have taken opposing views, including the WHO and the National Science Advisory Board for Biosecurity (NSABB).

No matter which side of the debate you come down on (pro science or pro security), the whole episode shows the glaring lack of clear and trusted international standards for dealing with these issues.

Q Why is scientist Ron Fouchier unhappy about his publication being delayed because he has to apply for an export licence to get his research published in the journal Science?

A Scientists like Ron Fouchier believe that their work is scientifically very important, and can actually help with improving international pandemic preparedness planning. Any restrictions on research could delay these improvements and potentially be a risk to human health. More generally, scientists tend to favor an open and transparent approach to knowledge, and guard their academic freedom.

Q Why then did Fouchier and Kawaoka agree to have the science detail redacted from their articles?

A Strictly speaking, the recommendation by the NSABB is not legally binding. It is only a recommendation. Although I have not interviewed the scientists involved, the level of controversy around this research, as well as the unprecedented nature of the intervention of the NSABB, was such that all parties agreed to a moratorium to figure out the best way forward.

Q Just how realistic a fear is it that terrorists could use the research papers to infect huge populations with the virus?

A The scale of the threat of bioterrorism is subject to highly divergent assessment, even among experts. Some terrorist groups have expressed interest in developing biological weapons. So far, however, attacks have been very rare, and have been comparatively limited in their scale, such as the Anthrax attacks of October 2011 in the USA.

Q How serious a threat is avian flu? Is it really a killer?

A Avian flu is already a serious killer – albeit mostly of birds. Luckily, the virus is not yet able to spread easily from human to human. Currently almost anyone with avian flu has caught it directly from birds. If it became possible to pass from human to human the spread of the disease would increase rapidly and therefore it would become a serious global threat. Much would then depend on the precise characteristics of the virus, and whether anti-viral medications and vaccines work against it (and whether enough of these are available around the world). According to the WHO, as of April 2012, there have been 602 cases and 355 human deaths of H5N1 officially reported - mostly in Indonesia, Vietnam and Egypt. 

Q What is the purpose of creating a version of the virus that can pass from mammal to mammal?

A The scientists are trying to figure out which mutations would have to occur for the virus to become more transmissible. Once they have done this, they can then risk-assess naturally-evolving H5N1 viruses, knowing exactly which mutations to look out for in terms of a possibly pandemic strand of the virus emerging naturally. This means they will be better prepared to fight a pandemic.

Q Are there any other examples of scientific academic freedom being infringed by Government?

A Yes. Although limiting academic freedom is always controversial, it is far from unprecedented. In medical research, for example, patient data is often kept confidential in order to protect the personal information of the patients. Sometimes scientists also rightly place restrictions on research voluntarily. For example, most research is subject to ethical review, and will not be approved by universities unless is meets rigorous standards of research ethics. Although this is not a government requirement, it shows that academic freedom has to be balanced with other values and objectives.

Q Why did you decide to hold this avian flu research debate?

A The stakes of the debate were huge – both for citizens in the UK and around the world, given the human and economic damage a pandemic could cause. The stakes were also very high for researchers and universities, given that this debate goes to the heart of how research is governed, and whether scientists feel that they have the freedom to pursue the scientific work they think is important. That is why in our debate we invited experts from the NSABB (Professor Harvey Rubin), on health security and the WHO (Professor David Heymann), on biomedical research ethics (Professor Bobbie Farsides), and on dual-use research (Dr Caitriona McLeish). We hoped it would provide the audience with a better understanding of the stakes and complexities of the issue.

Q What’s the role of the University’s new Centre for Global Health Policy?

A The Centre is dedicated to advancing the research base for global health policy. Its vision is a world in which all peoples can enjoy long, healthy lives irrespective of where they live, and in which all those in need have ready access to effective, affordable, and compassionate healthcare. It is a vision based around the social values of justice, dignity, and respect for human life. We will look at how the evolving international political environment shapes and constrains global health policy; at how global health policy is made and at how power influences global health outcomes − especially funding and resource distribution, economic inequalities, and the role of special interests.

Q What’s your view, as an academic researcher, of the controversy?

A There are plenty arguing for wide-ranging academic freedom (which I am very sympathetic to as a scholar); but there are also others who have genuine security concerns. What we need, therefore, is a much more systematic and international approach to governing the issues around dual-use research – that is, research with both a civilian and military application.

The outcry by the scientific community about the unprecedented attempts to censor part of the publications shows that the scientific community does not yet trust the mechanisms that have been developed. Moreover, the fluctuating stance of the NSABB on the issue, as well as the subsequent attempts by the Dutch government to impose further export restrictions on one of the studies (which was carried out in Holland) shows that these mechanisms do not yet have an established track record that encourages trust in the system.

Over 10 years since 9/11 and the Anthrax attacks, what we have still is a thorny set of issue around dual-use research, and we still do not have credible international mechanisms for governing these issues. It is clear that such a process will now need to be initiated, and it is very important that universities have a voice in this process.

Posted on behalf of: The Sussex Alumni Network
Last updated: Monday, 28 May 2012