After the government asked journals to cut two studies, concerns about censorship took center stage, but what does it mean for research?
When the U.S. government asked two major scientific journals, Science and Nature, to cut portions of studies that detail how to create and transmit mutant isolates of influenza A/H5N1 between ferrets, the public's reaction was, well, mixed. Many academics and First Amendment advocates cried censorship. Some sided with the National Science Advisory Board for Biosecurity, agreeing that such information could be used by terrorists. Relatively few considered this request's ramifications on bird-flu research.
Better late than never, Science published, yesterday, a set of Policy Forum articles "exploring the implications of research on H5N1 avian influenza and the virus' potential to spread among humans." Two of them are especially noteworthy, not just because they directly oppose one another, but more so because one advocates a research strategy grounded on fear, while the other, on hope.
While there is no correct stance on this debate -- at least not yet -- these commentaries are worth considering because they re-frame this often-sensationalized discussion into what it really is: a health issue.
The pessimistic piece (PDF), written by the University of Minnesota's Michael T. Osterholm and University of Pittsburgh's Donald A. Henderson, emphasizes the deadly nature of the virus, calling efforts to detect and respond to outbreaks "unrealistic" and reiterating that such information should not be given to those who may have "nefarious purposes." Some highlights:
One fact must be kept in mind. The current circulating strains of influenza A/H5N1, with their human case fatality rate of 30 to 80 percent, places this pathogen in the category of causing one of the most virulent known human infectious diseases.
Moreover, detecting an emerging pandemic virus in animals before the occurrence of a human pandemic is unrealistic. The six countries of the world where highly pathogenic avian influenza H5N1 is endemic (Bangladesh, Cambodia, China, Egypt, Indonesia, and Vietnam) ... are not often able to detect and respond to influenza A/H5N1 infections in birds. Experiences with pandemic H1N1 show the problems of a strategy based on the assumption that an emerging influenza pandemic could be identified quickly in a localized geographic area with no, or very limited, travel in or out of the pandemic zone.
The desire to disseminate the entirety of the methods and results of the two H5N1 studies in the general scientific literature will not materially increase our ability to protect the public's health from a future H5N1 pandemic. Even targeting dissemination of the information to scientists who request it will likely not enhance the public's health. Rather, making every effort to ensure that this information does not easily fall into the hands of those who might use it for nefarious purposes or that a biosafety accident resulting in an unintended release does not occur should be our first and highest priority.
The other (PDF), by Daniel R. Perez of the University of Maryland, takes a decidedly different tack. Though Perez agrees that a bird-flu pandemic is indeed very dangerous, he argues that this is all the more reason not to stifle research efforts. There is still much to learn, he says, and fear is counterproductive. Some highlights:
The uncontrolled spread of H5N1 viruses in poultry continues to pose a major pandemic threat. If we do not "take the bull by the horns" and make a worldwide concerted effort to help countries eradicate H5N1 viruses from domestic poultry, we will continue to face a potential H5N1 influenza pandemic.
We are at the infancy stage when it comes to predicting the transmission potential of influenza strains. In this regard, the independent work by Fouchier and Kawaoka's groups showing that H5N1 can be transmitted by respiratory droplets in the ferret model is of great importance. Ferrets are considered the best animal model for predicting the transmission of influenza in humans. If there ever was a sense of complacency about H5N1 viruses, these studies are a wake up call. Preventing access to crucial pieces of information will hamper our ability to develop better vaccines and antivirals against these viruses.
We failed at containing the 2009 pandemic influenza simply because, among other factors, we do not have a comprehensive understanding of what makes an influenza strain transmissible in humans. We still do not know whether an H5N1 virus that gained the capacity to transmit by respiratory droplets in ferrets can effectively transmit by the same route in humans. We now do know that the potential is there, but it is not through fear that we will stop H5N1 from becoming pandemic. The pursuit of knowledge is what has made humans resilient, a species capable of overcoming our worst fears.
Update: Science and Nature just released a joint letter (PDF) signed by 39 scientists, including Perez, declaring a voluntary 60-day pause on avian flu research and their intention to hold an international forum for these issues. Some highlights:
We recognize that we and the rest of the scientific community need to clearly explain the benefits of this important research and the measures taken to minimize its possible risks. We propose to do so in an international forum in which the scientific community comes together to discuss and debate these issues. We realize that organizations and governments around the world need time to find the best solutions for opportunities and challenges that stem from the work. To provide time for these discussions, we have agreed on a voluntary pause of 60 days on any research involving highly pathogenic avian influenza H5N1 viruses leading to the generation of viruses that are more transmissible in mammals. In addition, no experiments with live H5N1 or H5 HA reassortant viruses already shown to be transmissible in ferrets will be conducted during this time. We will continue to assess the transmissibility of H5N1 influenza viruses that emerge in nature and pose a continuing threat to human health.
Image: Stringer India/Reuters .