Scientists are creating a dangerous flu strain, just to prove they can

In an outrageous display of chutzpah, a group of flu researchers led by Ron Fouchier of Erasmus Medical Center in the Netherlands announced today, in a letter to the journal Nature, that they were planning to engineer the new H7N9 avian flu strain to give it new, possibly much more deadly capabilities.  Fouchier is the same scientist who, two years ago, adapted the highly pathogenic H5N1 flu strain so that it could be passed from human to human, which it cannot do in its natural form.  The resulting outcry delayed publication of his paper, but it eventually did appear.

Now they want to do the same thing, and much more, with the new H7N9 influenza virus, which has killed 43 people in China to date, and which epidemiologists are tracking with great concern.

They should track Fouchier and his lab instead.

Wait a second, protests Fouchier.  He promises that

"All experiments proposed by influenza investigators are subject to review by institutional biosafety committees. The committees include experts in the fields of infectious disease, immunology, biosafety, molecular biology and public health; also, members of the public represent views from outside the research community."

Sorry, but I'm not reassured.  Fouchier's group wants to do this research because it's all they know how to do - and, I suspect, because they enjoy the publicity.  Despite their claims that the research is vital to our understanding of the flu, none of their past work, including their work on H5N1, has changed our ability to respond to a pandemic.  As flu expert Michael Osterholm said in a report by the Associated Press:

"H5N1 surveillance is as haphazard today as it was two years ago. Should we do the work if it's not actually going to make a difference?"

Precisely.  Fouchier and his colleagues can't do surveillance, nor do they work on vaccine development.  They have laboratories where they can engineer the flu virus to make new strains, so that's what they want to do. Two years after their controversial H5N1 experiments, they haven't contributed to any improvement in our ability to control a pandemic, nor have they shown how to develop a better flu vaccine.  The benefits of creating a deadly new H7N9 virus are marginal, at best.

What about the risk? As reported in the Daily Mail, Fouchier and his colleague Yoshihiro Kawaoka themselves said

"H7N9's pandemic risk would rise 'exponentially' if it gained the ability to spread more easily among people."

Really?  And from this they conclude that it's a good idea to engineer a virus that can do exactly that - spread more easily among people? Are we supposed to take this risk because of some theoretical benefit from a vague "better understanding" of how mutations in the virus change its pathogenicity?

Although Fouchier is in Rotterdam, the NIH funds part of his work through the National Institute of Allergies and Infectious Diseases (NIAID).  Dr. Anthony Fauci, the head of NIAID, offered the reassurance that a special panel will review this H7N9 project, and

"If the risk is felt to be too high by this outside review, they will recommend it won't be done and we won't fund it."

Despite this additional oversight, I remain skeptical. These special panels tend to include other scientists who are very sympathetic with the work they're reviewing, as was demonstrated two years ago when the H5N1 work was published despite the grave concerns expressed by many outside the field.  I predict they will approve Fouchier and Kawaoka's experiments.

Here's a thought: put me on the panel: I've published multiple research papers on the influenza virus (including this paper in Nature and this paper on H5N1 avian flu), so I think it's fair to say I'm qualified.  But somehow I doubt they will do that.

The anthrax vaccine boondoggle

The anthrax vaccine is a truly bad idea. The U.S. has wasted billions of dollars on it, and it just seems to go from bad to worse. Now a government panel has recommended that we test the vaccine on children, which raises a whole new array of ethical questions.

Don't get me wrong: vaccines are the greatest boon to public health of the last 200 years. We eradicated smallpox, we're close to eradicating polio, and childhood deaths from infectious diseases are far, far lower thanks to the vaccines we give our children. These are truly wondrous advances.

But the anthrax vaccine is different, from start to finish.

For starters, anthrax is not infectious. This might come as a surprise to those who've only heard about this through the media. An anthrax "outbreak" is impossible, because the B. anthracis bacterium cannot spread from person to person. Vaccines against diseases such as measles, mumps, and influenza protect millions of people each year, because these are common infectious diseases that spread easily between people.

Anthrax was never a public health threat, and it isn't one now. We don't need an anthrax vaccine. And by developing and then promoting one, the government is abusing the good will that the public has towards vaccines, possibly endangering the public health further by playing into the hands of the anti-vaccine movement.

The Centers for Disease Control (CDC) does not recommend that children be vaccinated against anthrax. In fact, it doesn't recommend that anyone get routine vaccinations against anthrax:

"Vaccination is recommended only for those at high risk, such as workers in research laboratories that handle anthrax bacteria routinely."

The CDC recommendation makes sense. Therefore I was stunned to learn this week that the National Biodefense Science Board (NBSB) recommended that we launch an anthrax vaccine testing program in children (see page 37 of their report).

The NBSB report admits that

"Currently, U.S. children are not at immediate risk from anthrax and would not benefit directly from pre-event AVA [anthrax vaccine] administration."

It also states that

"There is no known benefit to vaccinating children in the absence of an imminent threat from exposure to B. anthracis other than potential future benefit."

Case closed, right? We can't conduct vaccine trials in children if there's no benefit.

Somehow, though, even after these statements in their own report, the NBSB managed to recommend testing the vaccine in children. As justification, they present this claim:

"Preparation for a national and potentially global threat from the use of B. anthracis spores by terrorists is a major priority for U.S. national security."

This is a massive overstatement. A national and global threat? Anthrax is not infectious, as the NBSB knows. The only people affected in an attack would be those directly exposed to the bacterium, likely only a handful of people. We don't vaccinate millions of people just to protect a hypothetical few: this is an abuse of the public trust in vaccines.

So why are we wasting billions of dollars to develop, test, and administer a vaccine against something that hardly infects anyone? The anthrax vaccine development project was on its way to being cancelled by the U.S. before the 2001 anthrax attacks. In an ironic twist, the likely perpetrator of the attacks, Bruce Ivins, was allegedly motivated by his interest in reviving the anthrax vaccine program. If so, then he succeeded in a big way: in 2004, the government announced Project Bioshield, which dedicated $5.6 billion to biodefense, much of that going to anthrax vaccine research.

I'm not surprised that if the government dedicates billions of dollars to biodefense, and distributes it to companies and universities who then become dependent on these funds, then advisory panels such as the NBSB will recommend an ever-increasing number of security measures. After all, some of the members of that committee are funded by biodefense dollars, and if we cut the funding, their own livelihoods might suffer.

Speaking to the Washington Post, panel member Ruth Berkelman said:

“We need to know more about the safety and immunogenicity of the vaccine as we develop plans to use the vaccine on a large number of children in the event of a bioterrorist’s attack.”

No, we don't. We don't need to know about the safety of the vaccine in children because it would be unethical to test it on them. And if there is an attack, we shouldn't respond by vaccinating "a large number of children," because anthrax doesn't spread from person to person. This is one vaccine we can do without.

[Note: I was a member of the research group that sequenced the DNA of the B. anthracis used in the 2001 attacks. We published our findings in two papers, one in 2002 and the second, after the investigation concluded, in 2011.]

It's time to destroy our smallpox

The eradication of smallpox was possibly the greatest victory of science over disease in the history of mankind. Thanks to a determined, worldwide vaccination effort, led by the World Health Organization, the last known human smallpox case occurred over 30 years ago, in Somalia in 1977. The WHO declared smallpox eradicated in 1980.

But smallpox isn't completely gone. That's because two large government laboratories, one in the U.S. and one in Russia, insist on maintaining stocks of the smallpox virus (called variola). In the U.S., the smallpox virus is kept at the Centers for Disease Control in Atlanta. In Russia, it's at the Vector lab in Siberia.

Why keep this incredibly deadly virus around? The scientists at the CDC and in Russia give the same answer: more research is needed to develop better vaccines, to protect us from a bioterrorism attack. "We still have work to do to protect the public," said Ali Khan, a smallpox researcher at the CDC, quoted just last week in the Washington Post.

They've been making this argument for 30 years now, but they are wrong. The only thing they need to do is to destroy their stocks of smallpox, and wipe out this virus once and for all. This seems like an obvious thing to do, but it's obvious now that the scientists whose jobs depend on keeping the smallpox around will never agree to destroy it. Nor will their bosses at the CDC. Yet keeping the smallpox around dramatically increases the risk that a deranged person will get his hands on it and release it in the population.

A smallpox outbreak would indeed be a frightening scenario: smallpox has a mortality rate of 30-35%, and it has been called one of the most devastating diseases in the history of mankind. In the 18th century, it killed 400,000 Europeans each year, and in the 1950s it was still infecting 50 million people a year worldwide. Routine vaccination ended about 35 years ago, which would make an outbreak today truly devastating. But an outbreak cannot happen if we destroy the smallpox that the U.S. and Russia are still holding.

Back in 1999, the WHO set a deadline to destroy the remaining smallpox samples, but the U.S. and Russia have repeatedly delayed action. At the 2006 meeting of the World Health Assembly (WHA), virtually every country agreed, again, that the smallpox should be destroyed, but the U.S. and Russia objected, and no date was set to destroy the remaining stocks. The WHA will meet again this coming May, and smallpox will be on the agenda. Unless President Obama takes a firm stand, I expect that the U.S. will once again insist on keeping its smallpox stores.

Experts such as D.A. Henderson, who led the effort to eradicate smallpox, have pointed out that we can develop new vaccines without the virus. The genome has been sequenced several times over, and we have the technology to synthesize parts of the virus if we really need it for vaccine design. Despite these facts, the old guard at the CDC will never agree to destroy their smallpox willingly.

President Obama: here is an opportunity to do the right thing. You can order the CDC to destroy their stocks of smallpox, and eliminate this unnecessary risk from the planet. The United States can and should take the moral lead on this public health threat, rather than stonewalling once again at the next World Health Assembly. Destroy the smallpox, and wipe out this scourge once and for all.