Royal Society H5N1 Symposium: Day 2

 

 

# 6260

 

At 4 am EDT, 9 am BST (UTC+1), day two of the Royal Society’s H5N1 research: biosafety, biosecurity and bioethics symposium will get underway.

 

This two-day event is being live-streamed on the internet, and the full video will soon be made available on the Royal Society’s website.

 

Lisa Schnirring of CIDRAP news provides us with an excellent overview of the first day’s presentations.

 

H5N1 mutations, other details unveiled at H5N1 meeting

Lisa Schnirring Staff Writer

Apr 3, 2012 (CIDRAP News) – New details about H5N1 transmission studies emerged today during a Royal Society conference on the topic in London, but with Dutch export restrictions blocking what one research group could share.

Scientists who led the two studies in question both took the stage during the first day of a 2-day meeting to discuss a host of issues on the topic, from basic research to ethics. The Royal Society is offering a live webcast of the meeting.

 

(Continue . . .)

 

 

 

Today’s offerings should be quite lively, with perspectives from the scientific publishing sector, the media, Professor Peter Doherty, Professor Arthur Caplan, and an extended Q&A session.

The Scientist: Deliberating H5N1 Research

 

 

# 6256

 

The decision on Friday by the NSABB to clear the way for the publication of the Fouchier and Kawaoka research papers has not lessened the debate over the risks and benefits of DURC (Duel Use Research of Concern).

 

Today The Scientist published an extended debate over the appropriateness of this type of research, soliciting opinions on three different questions from a variety of experts.

The questions being:

 

QUESTION 1: To Research or Not to Research?

QUESTION 2: To Publish or Not to Publish?

QUESTION 3: How to Regulate?

 

Responding to these issues are Rob Carlson, Peter Doherty, Richard H. Ebright ,David L. Heymann, Michael J. Imperiale, Yoshihiro Kawaoka, Lynn Klotz,Randall Murch, Daniel Perez,John Steinbruner, and Ed Sylvester.

 

Follow the link below to read:

 

 

Deliberating Over Danger

 

The creation of H5N1 bird flu strains that are transmissible between mammals has thrown the scientific community into a heated debate about whether such research should be allowed and how it should be regulated.

April 1, 2012

NSABB To Re-examine H5N1 Research Risks

 

# 6249

 

 

Today and tomorrow the NSABB (National Science Advisory Board for Biosecurity) will reconvene to re-examine the issues surrounding the publication of controversial H5N1 research that produced a ferret-transmissible strain of bird flu.

 

Last September, Ron Fouchier from the Netherlands (and almost simultaneously Professor Yoshihiro Kawaoka from Wisconsin) announced success in creating enhanced strains of the avian flu virus in the laboratory, which subsequently unleashed a firestorm of controversy.

 

For some background, see Katherine Harmon’s Sci-Am article , New Scientist: Five Easy Mutations, & NPR: Bio-Terrorism Concerns Over Bird Flu Research.

 

Over the ensuing six months we’ve seen a steady stream of opinion pieces from both sides of this debate (see H5N1 Research: A Plethora Of Positions), including side forays into the lethality of the H5N1 virus (see The Great CFR Divide).

 

This week we’ve seen the release of additional dueling commentaries, three of which Lisa Schnirring of CIDRAP NEWS  highlighted last night in her article:

 

Scientists volley ahead of more dual-use H5N1 debate

Lisa Schnirring Staff Writer

Mar 28, 2012 (CIDRAP News) – As researchers from both sides of the debate over two controversial H5N1 studies weighed in yesterday on full publication versus a more cautionary approach, two US journals said they are developing policies to address any future such instances.

(Continue . . .)

 

 

The NSABB serves strictly in an advisory role, and any policy decisions must come from the United States government. Nonetheless, all eyes will be on the NSABB as they consider this issue.

 

And I can think of no one better than Helen Branswell  of the Canadian Press to preview this meeting for us:

 

Biosecurity panel reconvenes to reexamine controversial bird flu studies

3-28-12 6:31 PM EDT  By Helen Branswell

A bid from some quarters in the U.S. to resolve the ongoing controversy over two unpublished bird flu studies will begin to play out over the next two days as government biosecurity advisers reconvene to reconsider the issue.

 

The National Science Advisory Board for Biosecurity will meet Thursday and Friday in Washington, D.C., to go over revised versions of the two studies and hear about the work from their principal authors, noted flu virologists Ron Fouchier of Erasmus Medical Centre in Rotterdam, the Netherlands, and Yoshihiro Kawaoka of the University of Wisconsin-Madison.

(Continue . . . )

Dysfunctional Science

 

 

# 6246

 

 

Six weeks ago in Science at the Crossroads, I wrote about the decline the public’s trust in science.

 

While I cited a number of reasons for this disturbing trend, prime among them has been the abrupt rise in the number of scientific papers that have been retracted – sometimes for outright fraud - over the past decade.

 

Today the editors-in-chief of two prominent journals  made a presentation before a committee of the National Academy of Sciences, where they warn of a growing dysfunction in scientific research, and call this rise in retracted studies a symptom of a much larger problem.

 

You’ll find detailed and thought provoking editorials authored by Ferric C. Fang, Editor in Chief, Infection and Immunity and Arturo Casadevall, Editor in Chief, mBio on the challenges facing researchers in the current issue of Infection and Immunity (IAI).

 

The press release from the American Society for Microbiology follows, with the links to a pair of Infection and Immunity editorials on the subject at the end.

 

Highly recommended.

 

 

 

Has modern science become dysfunctional?

The recent explosion in the number of retractions in scientific journals is just the tip of the iceberg and a symptom of a greater dysfunction that has been evolving the world of biomedical research say the editors-in-chief of two prominent journals in a presentation before a committee of the National Academy of Sciences (NAS) today.

 

"Incentives have evolved over the decades to encourage some behaviors that are detrimental to good science," says Ferric Fang, editor-in-chief of the journal Infection and Immunity, a publication of the American Society for Microbiology (ASM), who is speaking today at the meeting of the Committee of Science, Technology, and Law of the NAS along with Arturo Casadevall, editor-in -chief of mBio®, the ASM's online, open-access journal.

 

In the past decade the number of retraction notices for scientific journals has increased more than 10-fold while the number of journals articles published has only increased by 44%. While retractions still represent a very small percentage of the total, the increase is still disturbing because it undermines society's confidence in scientific results and on public policy decisions that are based on those results, says Casadevall. Some of the retractions are due to simple error but many are a result of misconduct including falsification of data and plagiarism.

 

More concerning, say the editors, is that this trend may be a symptom of a growing dysfunction in the biomedical sciences, one that needs to be addressed soon. At the heart of the problem is an economic incentive system fueling a hypercompetitive environment that is fostering poor scientific practices, including frank misconduct.

 

The root of the problem is a lack of sufficient resources to sustain the current enterprise. Too many researchers are competing for too little funding, creating a survival-of-the-fittest, winner-take-all environment where researchers increasingly feel pressure to publish, especially in high-prestige journals.

 

 

"The surest ticket to getting a grant or job is getting published in a high profile journal," says Fang. "This is an unhealthy belief that can lead a scientist to engage in sensationalism and sometimes even dishonest behavior to salvage their career."

 

Funding is just one aspect of a very complex problem Casadevall and Fang see growing in the biomedical sciences. In a series of editorials in the journal Infection and Immunity they describe their views in detail, arguing that science is not as healthy as it could be or as it needs to be to effectively address the challenges facing humanity in the 21st century.

 

"Incentives in the current system place scientists under tremendous stress, discourage cooperation, encourage poor scientific practices and deter new talent from entering the field," they write. "It is time for a discussion of how the scientific enterprise can be reformed to become more effective and robust."

 

The answers, they write, must come not only from within the scientific community but from society as a whole that has helped create the current incentive structure that is fostering the dysfunction. In the editorials they outline a series of recommended reforms including methodological, cultural and structural changes.

 

"In the end, it is not the number of high-impact-factor papers, prizes or grant dollars that matters most, but the joys of discovery and the innumerable contributions both large and small that one makes through contact with other scientists," they write. "Only science can provide solutions to many of the most urgent needs of contemporary society. A conversation on how to reform science should begin now."

 

###

Copies of the Infection and Immunity editorials can be found online at

http://iai.asm.org/content/80/3/891.full

and

http://iai.asm.org/content/80/3/897.full

Laurie Garrett Dissects The Rationale For H5N1 Research

 

BSL-4 Lab Worker - Photo Credit –USAMRIID

 

# 6237

 

 

Pulitzer-prize winning journalist and author Laurie Garrett has a new blog up today where she once again takes a hard look at the H5N1 research controversy (see The Furor Over H5N1 Research Continues), and this time dissects the rationale being offered by scientists for doing these types of experiments.

 

Follow the link below to read:

 

Rationales for Man-made H5N1 Experiments Evaporating?

 

You can read some of her earlier takes on this controversy at the following links:

 

Laurie Garrett Blogs On The H5N1 Research Controversy

Laurie Garrett: Keeping Superbugs Away From Terrorists

Referral: Laurie Garrett On The Bird Flu Research Controversy

The H5N1 Research Credibility Gap

 

BSL-4 Lab Worker - Photo Credit –USAMRIID

# 6214

 

 

As blogger fodder, one could hardly ask for a better controversy than the current row over mutating the H5N1 virus in the lab to create a `better pathogen’.

 

Something that, while only recently making headlines, has been a goal of a number of labs around the world for several years (see here, here, and here for examples).

 

But with the apparent success of Ron Fouchier’s ferret experiments in the Netherlands, the hypothetical has suddenly become a reality (see Katherine Harmon’s Sci-Am article & New Scientist: Five Easy Mutations), instantly setting off alarm bells in the biosecurity world.

 

Fouchier’s, (and almost simultaneously) Professor Yoshihiro Kawaoka’s in Wisconsin, announcement that they had created mammalian adapted and transmissible strains of the avian H5N1 virus have unleashed a firestorm of controversy.

 

And as a flu blogger, you’d think I’d be at least a little bit happy about all this.

 

After all, I don’t have a financial stake in the outcome, and it provides fresh and controversial content nearly every day.

 

We’ve got the highly explosive issue of scientific and academic freedom versus concerns over public safety and biosecurity.

 

And if that were not enough, we’ve some of the biggest names in virology and influenza research engaged in public, and at time vigorous, debate.

 

It would seem like a win-win from my perspective.

 

But it isn’t.

 

As I wrote several weeks ago in Science at the Crossroads, the public’s trust in science is in serious decline, and some of the blame for that surely lies in the conduct of the scientific community.

 

Quite frankly, this confusing (and often unseemly) debate over bird flu research we’ve witnessed these past few months hasn’t done  much to help matters. 

 

 

Of particular concern across much of flublogia have been attempts to recast the H5N1 virus as being not much worse than seasonal flu, and the sudden revision by Ron Fouchier of his research results (see ASM BioDefense Meeting Video Now Online).

 

Earlier this week Laurie Garrett took aim at this `kinder and gentler’ version of Fouchier’s ferret research (see Laurie Garrett Blogs On The H5N1 Research Controversy).

 

And yesterday, Helen Branswell weighed in with a report of her own, where she interviews a number of well-respected researchers who also express concerns over how this debate is progressing.

 

If you haven’t already done so, I’d invite you to read:

 

 

The Canadian Press - ONLINE EDITION

Scientists fear row over bird flu studies may undermine credibility of the field

By: Helen Branswell, The Canadian Press

TORONTO - As influenza scientists and biosecurity experts continue to do battle over controversial bird flu studies, some in the flu world worry arguments being used to push for full publication of the studies may be eroding the credibility of the field.

(Continue . . . )

 

 

We are entering a new era of scientific discovery, one where great things are possible – particularly in the life sciences fields.  Bio-engineering, many scientists believe, could revolutionize the world.

 

But those advances will be for naught if the public loses faith in the science, or the scientists.

 

You can create a genetically modified dengue-resistant mosquito, but if the public fears it more than the disease, all you have is an expensive laboratory curiosity.

 

And a universal flu vaccine – one that could forever stave off the global threat of influenza pandemics -only works if it is accepted by the vast majority of the public as being safe, effective, and necessary.

 

No one expects science to always get it right, or for scientists to always agree. In fact, the disagreements are what propel scientific research and advance our knowledge.

 

But how these disagreements are publically handled - and how difficult concepts such as uncertainty and risk in conducting life science research are presented to the public - will determine whether science ultimately manages to keep hold of the public’s trust.

 

And that’s a prize that science can ill afford to lose.

Laurie Garrett Blogs On The H5N1 Research Controversy

 

# 6205

 

 

Laurie Garrett, Pulitzer-prize winning journalist (1996 for her series on Ebola) and author of 3 books (including The Coming Plague: Newly Emerging Diseases in a World Out of Balance), takes on a subject which has perplexed many of us in Flublogia over the past week:

The `kinder and gentler’ version of Ron Fouchier’s ferret experiments presented at last week’s ASM BioDefense panel discussion (see ASM BioDefense Meeting Video Now Online).

 

At the time I noted:

 

In a bit of a surprise, Erasmus University researcher Ron Fouchier characterized the results of his experiments somewhat differently than we’ve seen in the past.

 

While the mutated virus could be spread via the aerosol route between ferrets, Fouchier reassured, "Our data suggests this virus spreads very poorly."

 

Fouchier also downplayed the pathogenicity of virus, stating that ferrets infected this way only suffered mild illness (it required direct deep-lung inoculation to produce death/severe illness).

 

“It is not highly lethal if ferrets start coughing and sneezing to one another”, he said.

 

 

With the research currently restricted to a small group of scientists and policy makers, it makes it very difficult for anyone on the outside to make sense of all of this.

 

But Laurie Garrett isn’t just anyone. 

 

Today she takes a hard look at this reversal, and other attempts to characterize the H5N1 virus as `far less pathogenic than feared’, in her blog.

At this point I’ll wisely step aside and invite you to read:

 

Much Ado About What? The H5N1 Story Gets Murkier Every Day

mBio: The H5N1 Biosafety Level Debate

 

UPDATED: mBio has published4 editorial/commentary pieces on the H5N1 research debate.  I’ve posted the links at the bottom of this blog post.

 

 

 

# 6197

 

 

Later today mBio will publish a pair of opposing views on what level of  laboratory biosecurity (BSL-3 or BSL-4) should be required in order to work on the H5N1 virus.

 

While there are many differences in procedures between them, in the broadest definition under BSL-3 it is the pathogen that is kept isolated, and worked on in specially designed negative airflow biological safety cabinets (BSC). Lab personnel wear fairly standard PPEs (Personal Protective Equipment) in BSL-3 labs.

 

With enhanced BSL-4 security, the focus is on isolating and protecting lab workers from the pathogen, and so they must all wear fully contained BSL-4 `space suits’, and decontaminate before leaving the work area.

 

BSL-4 labs work on the most dangerous pathogens that pose a particularly high risk of infection, such as Marburg, Ebola, Lassa fever, CCHF, and smallpox.

 

BSL-4 labs are far more expensive to build and maintain than BSL-3 facilities, and there are not nearly as many of them around the world.

 

Which presents a dilemma.  If you restrict work on the H5N1 virus to only BSL-4 labs, that would exclude many universities (and even entire countries) from being able to conduct research on the virus.

 

You may recall that early in February Canada restricted H5N1 research to BSL-4 facilities (see  Canada Issues Biosafety Advisory For H5N1 Research).

 

Although the mBio articles won’t be published for a few more hours, we’ve got a press release with some of the details and a preview by Helen Branswell.

First stop, the press release from the American Society for Microbiology

 

New H5N1 viruses: How to balance risk of escape with benefits of research?

In the controversy surrounding the newly developed strains of avian H5N1 flu viruses, scientists and policy makers are struggling with one question in particular: what level of biosafety is best for studying these potentially lethal strains of influenza? In a pair of commentaries, researchers from the Mount Sinai School of Medicine in New York and the University of Michigan argue their different views of how to safely handle H5N1 flu viruses. The commentaries will be published in mBio®, the online open-access journal of the American Society for Microbiology, on Tuesday, March 6.

 

This fall, the U.S. National Science Advisory Board for Biosecurity (NSABB) set off a debate when it asked the authors of two recent H5N1 research studies and the scientific journals that planned to publish them to withhold crucial details of the research in the interest of biosecurity. The researchers had taken H5N1, a virus that cannot easily transmit from human to human, and developed strains of the virus that can transmit easily between ferrets, which are a common model for human influenza.

 

These H5N1 strains and others like them that might be developed in the future could pose a grave threat to human life, but researchers and others argue that studying these H5N1 strains could help bolster preparedness efforts and vaccine development to help fend off a potential H5N1 pandemic. How can we balance the need to protect human life from the accidental escape of an H5N1 strain with the need to continue research that might prevent a naturally occurring outbreak? Which biosafety level (BSL) is right for the H5N1 virus?

 

In the commentaries appearing in mBio, two experts offer opposing views of the appropriate level of security for dealing with H5N1 viruses. The authors agree that, with a reported case fatality rate that could be as high as 50% or more, H5N1 could create a pandemic of disastrous proportions, but they differ in their opinions of how to strike a balance between biosecurity and potentially life-saving research.

(Continue . . . )

 

Next up, from the Canadian Press, a preview from Helen Branswell.

 

The Canadian Press - ONLINE EDITION

Future work on lab-made bird flu viruses should be done in most secure labs

By: Helen Branswell, The Canadian Press

Posted: 03/6/2012 3:02 AM TORONTO - Future work on mutated bird flu viruses should only take place in laboratories with the highest level of biosafety, suggests a new commentary on the controversy over two studies that led to the creation of these viruses.

 

But an opposing view argues that to restrict work on the viruses to so-called BSL4 labs would not leave the world safer, but would impede the quest to find out how flu viruses that normally infect birds can adapt to infect people.

(Continue . . .)

 

Both opinion pieces should be online at 10am EST, March 6th, and available at this link.

 

Mammalian-Transmissible H5N1 Virus: Containment Level and Case Fatality Ratio

Arturo Casadevall and Thomas Shenk

doi:10.1128/mBio.00054-12

 

Working Safely with H5N1 Viruses

Adolfo García-Sastre

doi:10.1128/mBio.00049-12

 

Biosafety Considerations of Mammalian-Transmissible H5N1 Influenza

Michael J. Imperiale and Michael G. Hanna III

doi:10.1128/mBio.00043-12

 

Ferret-Transmissible Influenza A(H5N1) Virus: Let Us Err on the Side of Caution

Lisa N. Murillo

doi:10.1128/mBio.00037-12

Science Magazine: NSABB Members React To Fouchier Statement

 

 

# 6193

 

 

In the wake of the surprise announcement by Ron Fouchier earlier this week that the H5N1 virus he created is less lethal, and less transmissible than widely believed (see ASM BioDefense Meeting Video Now Online), we get reaction from a number of NSABB board members at the suggestion they take another look at his study.

 

Very much worth reading.

 

 

NSABB Members React to Request for Second Look at H5N1 Flu Studies

by Jon Cohen and David Malakoff on 2 March 2012,

Members of a U.S. government biosecurity advisory board are offering a range of reactions to the news that they are being asked to take a second look at two controversial flu studies. Some have not previously spoken publicly about the issue, which has sparked a global debate about biosecurity versus scientific freedom. And several say they are skeptical that the new review will reverse their opposition to fully publishing the methods and results of the two experiments.

(Continue . . .)

New Scientist: Mutant H5N1 Still Deadly

 

 

# 6191

 

 

Debora MacKenzie, writing for New Scientist, was one of the first journalists to report on Ron Fouchier’s experiments with a mutated form of H5N1 back in September of 2011, and quoted Fouchier as saying the virus `is transmitted as efficiently as seasonal flu.’

She also included in her lede: What's more, the virus is just as lethal despite the mutations.

 

And that was the story, widely reported by many media outlets, since the announcement at a Malta bird flu conference.

This week, however, during an ASM Biodefense panel discussion (see ASM BioDefense Meeting Video Now Online) we got a `kinder and gentler’ description of this mutated virus from Fouchier – one describing it as less than lethal (in ferrets), and `poorly transmitted’.

 

What, many of us have asked, is going on? 

 

Well, Debora MacKenzie is back with a follow up report today in New Scientist today, that attempts to reconcile the initial descriptions of this mutated virus with the new one delivered this week.

 

 

Mutant bird flu virus still as deadly as first thought

14:06 2 March 2012

Debora MacKenzie, consultant

 

 

If after watching the ASM video, and reading this report, you aren’t thoroughly confused, you obviously aren’t paying close enough attention.

ECDC Risk Assessment On H5N1 Transmissibility Studies

 

 

# 6185

 

 

Today the ECDC  released a Risk Assessment on the H5N1 transmissibility studies conducted by Fouchier and Kawaoka that illustrates the difficulty that all of us are having in assessing this story.

 

Outside of a closed circle of scientists, none of us have access to all the facts. 

 

And apparently, some of the details that have been reported –  according to Ron Fouchier at this morning’s ASM Biodefense webcast – have not been completely accurate.

 

All of which makes it very difficult to sit back and make any sort of informed judgment from the sidelines. The ECDC’s executive summary acknowledges these limitations by stating:

 

This document’s starting point is that without sight of data and analyses it is very difficult to undertake risk assessments. It is not even clear at present how pathogenic these viruses are in animal models. The
document also puts forward the ECDC position on some of these issues according to ECDC’s limited mandate, recognising the value of the research but also the potential risks.

 

ECDC stresses the need to consider mechanisms
for a robust biorisk-management approach along the lines of international standards and  EU-wide guidance on laboratory biosafety/biosecurity for any future emerging threats.

 

ECDC indicates that it would advocate open publication of the findings and emphasises the importance of sustaining and enacting the pandemic influenza preparedness framework with its underpinning global virological surveillance and sharing of information and benefits in order to enhance global health security.

 

It is ECDC’s intention to support the European Commission and Member States, to monitor these developments closely and with its stakeholders and collaborators to revisit its risk assessment for A(H5N1) viruses as the research findings emerge. 

 

 

Nonetheless, this ECDC risk assessment does a good job in defining many of the complex issues at hand, even if definitive answers are elusive. 

 

 

Risk assessment: Laboratory-created A(H5N1) viruses transmissible between ferrets

Technical reports - 29 Feb 2012

Available as PDF 

ABSTRACT

The results of two, as yet unpublished, investigations of laboratory-induced genetic changes in avian influenza A(H5N1) viruses have been reported to have found that a surprisingly few number of changes make the viruses transmissible between ferrets, the most commonly used model for the way influenza behaves in humans. The possibility that this could have resulted in the development in laboratories of A(H5N1) influenza viruses transmissible between humans has caused concern for public safety and generated unusually high levels of debate in the scientific community.

 

This report summarises and explains the complex public health and scientific issues around these developments including the positive and negative aspects of some of the responses that have been proposed internationally.

CIDRAP News: NSABB May Revisit H5N1 Research

 

 

# 6184

 

Robert Roos, News editor for CIDRAP News, has a detailed report on today’s ASM Biodefense panel discussion (see ASM BioDefense Meeting Video Now Online).

 

With new data presented by Ron Fouchier at this meeting, the NSABB may take another look at these studies.

 

 

With new data, NSABB may revisit H5N1 studies

Robert Roos News Editor

Feb 29, 2012 (CIDRAP News) – The mutant H5N1 virus generated in one of two controversial studies was less lethal and contagious than has been generally understood, and the US government's biosecurity advisory committee will be asked to examine new and clarified data from the study, scientists and government officials revealed today.

(Continue . . . )

 

Webcast: Discussion Of NSABB’s H5N1 Recommendations

 

 

# 6181

 

My thanks to Helen Branswell for tweeting this event.

 

Set you alarm clocks accordingly, as tomorrow morning (Wednesday, February 29th) the ASM Biodefense and Emerging Diseases Research Meeting will provide a live webcast of an hour-long discussion over the NSABB’s recommendations to redact portions of two H5N1 research papers.

 

Featuring: 

Michael T. Osterholm, Ph.D., MPH  NSABB/CIDRAP 

Anthony S. Fauci, M.D  (NIAID)

Bruce Alberts, Ph.D. Editor-in-Chief of Science

Ron A.M. Fouchier, Ph.D.    H5N1 Researcher

Live Stream Details
Date: Wednesday, February 29, 2012
Time: 7:15 a.m. - 8:15 a.m. EST
Link:

If you are unable to watch the live feed, a video should be posted by 1:00pm.

The Great CFR Divide

 

 

 

# 6173

 

 

Over the past two days we’ve seen two highly divergent papers come out on the probable spread, and Case Fatality Rate, of the H5N1 virus in the human population.

 

The lead author of the first one was Peter Palese and the second Michael Osterholm. Both are scientists of considerable reputation in the world of infectious diseases.

 

You can access them via my blogs below:

 

Science: Peter Palese On The CFR of H5N1

mBio: Mammalian-Transmissible H5N1 Influenza: Facts and Perspective

 

In 25 words or less, though:

 

Professor Palese maintains that seroprevalence studies suggest `millions’ of uncounted H5N1 infections, and would indicate the virus is nowhere near as deadly as has been proclaimed.

 

Osterholm cites flaws in some of those studies, and using WHO guidelines for testing, finds scant evidence to support the idea that many cases go uncounted, and the CFR is low.

 

Shamefully simplistic summaries on my part, but we’ve covered this territory many times in the past few days. I would encourage everyone to read both papers in their entirety.

 

In the wake of their publication, we are starting to see some media coverage and comparison of the two papers, and reactions from other scientists on this issue.

 

First stop, Reuters, which has a long report on this controversy, which was published before the mBio  paper was released this morning.

 

Bird flu may not be so deadly after all, new analysis claims

By Sharon Begley

NEW YORK | Fri Feb 24, 2012 6:38am EST

 

Despite the title, this report does quote the World Health Organization as standing behind their numbers, and has comments by Arturo Casadevall and Michael Osterholm disputing Palese’s results.

 

Next, New Scientist has a report by Debora MacKenzie that looks at the debate, and along the way she posits a theory of her own.

 

New doubt over H5N1 death rate – but risks still high

16:50 24 February 2012

 

 

And lastly, Lisa Schnirring of CIDRAP News has undertaken a difficult task and (skillfully, I think) has put together a comparison of the two papers.

 

She includes reactions from several leading scientists (including Gaun Yi and Marc Lipsitch) who have read the papers.

 

 

Debate on H5N1 death rate and missed cases continues

Lisa Schnirring Staff Writer

Feb 24, 2012 (CIDRAP News) – Two leading voices on the potential threat of lab-modified H5N1 viruses laid out their arguments about the human H5N1 fatality rate and undetected cases today and yesterday, with one group claiming "millions" likely have been infected and the other group saying current World Health Organization (WHO) fatality-rate estimates are about right.

 

(Continue . . . )

 

 

While this is a fascinating debate, and I know just about everyone would like to know the true CFR of the H5N1 virus (myself included), I’m not sure how much value (or comfort) that we would derive if we had that knowledge.

 

First, we tend to talk about the H5N1 virus as if it were a single, monolithic virus.

 

It isn’t.

 

There are more than 20 identified clades (and growing), with many minor variations within each clade.

 

 

 

If we could figure out the CFR for the clades commonly found in Indonesia (2.1.1, 2.1.2. and 2.1.3), it probably wouldn’t tell us much about those circulating in Egypt (2.2.1 and 2.2).

 

And it might tell us even less about the CFR of some future human-adapted H5N1 virus that may one day appear.

 

As any prospectus will warn you, Past performance is no guarantee of future results.

 

So even if we were accept that Professor Palese is correct, and the CFR of currently circulating H5N1 strains are somewhat less than 1%, I’m not exactly comforted by that knowledge.

 

I think what is important here is that this virus has been shown to provoke severe, often devastating illness in nearly all of the humans cases we’ve confirmed so far. It also seems to have a preference for younger victims.

 

Admittedly, that could change as the virus evolves.

 

But it is enough to convince me that we need to regard this virus as a dangerous and formidable pathogen, regardless of whether its CFR right now turns out to be 30%  or .3% or somewhere in between.

 

Because if a new and improved version of the virus ever emerges, all of the old arguments (and datasets) will quickly become academic.

Peter Sandman On H5N1 Research Risk Communications

 

 

# 6162

 

 

I’m a bit chagrinned to admit that I hadn’t checked Peter Sandman’s terrific risk communications website over the weekend in the wake of last Friday’s decision from the Technical consultation on H5N1  held in Geneva.

 

Had I, I would have found a long and thoughtful essay on the need for respectful dialog . . . not `education’ or one sided advocacy in ongoing H5N1 discussions.

 

While not experts in virology, or influenza, Dr. Peter Sandman and his wife and colleague  Dr. Jody Lanard, are often consulted on pandemic communication issues and are internationally recognized experts in all manner of risk communications.

 

Their website, quite frankly,  should be required reading for anyone who’s job it is to deal with the public during a crisis.

 

The Peter M. Sandman Risk Communication Website

 

Last Friday Dr. Sandman sent Lisa Schnirring of CIDRAP news  a long email with his thoughts on the press releases coming out of the Geneva meeting (see WHO News Release On Geneva H5N1 Technical Meeting).

 

Lisa subsequently incorporated some of his comments in her article on the meeting Friday night (see WHO H5N1 study group extends moratorium, calls for full publication).

 

Rather than delay further, I’ll simply invite you to visit Dr. Sandman’s site to read:

 

The H5N1 Debate Needs Respectful Dialogue, Not  “Education” or One-Sided Advocacy

by Peter M. Sandman

(a February 17, 2012 email to Lisa Schnirring of CIDRAP News )

 

 

Highly recommended.

Laurie Garrett Blogs On The H5N1 Research Controversy

 

 

# 6156

 

 

Laurie Garrett, Pulitzer-prize winning journalist (1996 for her series on Ebola) and  author of 3 books (including The Coming Plague: Newly Emerging Diseases in a World Out of Balance), has been writing extensively these past couple of months about the H5N1 research controversy.

I mentioned earlier essays of hers here and here, and she was part of the NYAS discussion panel on this research earlier this month which you can view at the following link:

 

"Dual Use Research: H5N1 Influenza Virus and Beyond" Panel Sparks Lively Debate

 

This week Garrett has also been blogging extensively while technical talks were held in Geneva over the fate of the Fouchier and Kawaoka research papers.

 

She is roughly at the halfway point of what she expects will be a weeklong series.   You can access all of them at her blog.

 

As of this posting, the following essays are up:

 

 The Man-made H5N1 Controversy Heats Up: What Next? (Part One)

 The Man-made H5N1 Controversy Heats Up: What Next? (Part Two)

 The Man-made H5N1 Controversy Heats Up: What Next? (Part Three A)

 The Man-made H5N1 Controversy Heats Up: What Next? (Part Three B)

The Man-made H5N1 Controversy Heats Up: What Next? (Part Four)

WHO News Release On Geneva H5N1 Technical Meeting

 

 

# 6153

 

The World Health Organization has posted a statement in the wake of this week’s Technical consultation on H5N1 research issues, which outlines the major points announced in today’s press conference.

 

 

Public health, influenza experts agree H5N1 research critical, but extend delay

WHO to convene additional meeting to discuss future protections

News release

17 February 2012 | Geneva - A small group of global public health and influenza experts at a WHO-convened meeting reached consensus on two urgent issues related to the newly created H5N1 influenza viruses: extending the temporary moratorium on research with new laboratory-modified H5N1 viruses and recognition that research on naturally-occurring H5N1 influenza virus must continue in order to protect public health.

 

“Given the high death rate associated with this virus -- 60% of all humans who have been infected have died -- all participants at the meeting emphasized the high level of concern with this flu virus in the scientific community and the need to understand it better with additional research," says Dr Keiji Fukuda, Assistant Director-General of Health Security and Environment for the World Health Organization. “The results of this new research have made it clear that H5N1 viruses have the potential to transmit more easily between people underscoring the critical importance for continued surveillance and research with this virus.”

 

WHO convened the meeting as a first step to facilitate the discussion of differing opinions that have arisen in recent months after two research groups, one in the Netherlands and the other based in the United States, have created versions of the H5N1 influenza virus which are more transmissible in mammals than the H5N1 virus that occurs naturally.

 

The experts at the meeting included lead researchers of the two studies, scientific journals interested in publishing the research, funders of the research, countries who provided the viruses, bioethicists and directors from several WHO collaborating-center laboratories specializing in influenza.

Consensus to delay publications

The group also came to a consensus that delayed publication of the entire manuscript would have more public health benefit than urgently partially publishing.

 

“There is a preference from a public health perspective for full disclosure of the information in these two studies. However there are significant public concern surrounding this research that should first be addressed,” says Fukuda.

 

Two critical issues are to increase public awareness and understanding of this research through communications and the review of biosafety and biosecurity aspects raised by the new laboratory-modified H5N1 influenza virus. WHO will continue discussion with relevant experts to move this forward.

 

Broad issues raised, but not limited to, these research studies will be discussed at future meetings convened by WHO soon with participation by a broader range of experts and interested parties relevant to these issues.

 

WHO Releases List Of Participants At H5N1 Meeting In Geneva

 

# 6148

 

Today the World Health Organization released the names of the 22 scientists invited to participate in the first technical consultation on H5N1 research currently being held in Geneva.

Reading like a WHO’s Who of global influenza specialists, this august group of scientists will meet behind closed doors over the next two days to discuss the fate of two research papers by Fouchier and Kawaoka that detail how they created a transmissible (in ferrets) strain of H5N1 in the lab.

 

 

Technical consultation on H5N1 research issues

WHO Headquarters, Geneva
16-17 February 2012

List of participants

Professor Tjandra Y. Aditama
Director-General of Disease Control and Environmental Health, Ministry of Health
Indonesia

Dr Philip Campbell
Editor-in-Chief Nature
United Kingdom

Dr Nancy Cox
Director, WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza, Centers for Disease Control and Prevention
United States of America

Dr Anthony Fauci
Director, National Institute of Allergy and Infectious Diseases (NIAID) National Institutes of Health (NIH)
United States of America

Professor Ron Fouchier
Institute of Virology, Erasmus Medical Center
Netherlands

Professor Didier Houssin
President, French Evaluation Agency for Research and Higher Education (AERES)
France

Dr Barbara Jasny
Deputy Editor for Commentary, Science/AAAS
United States of America

Dr Yoshihiro Kawaoka
Influenza Research Institute, University of Wisconsin
United States of America

Dr Paul Keim
Acting Chair, National Science Advisory Board for Biosecurity (NSABB), Division Director, Pathogen Genomics, Northern Arizona University
United States of America

Professor Anne Kelso
Director, WHO Collaborating Centre for Reference and Research on Influenza
Australia

Dr Willem Luytjes
National Institute for Public Health and the Environment (RIVM)
The Netherlands

Dr Le Thi Quynh Mai
Head of Virology Department, National Institute of Hygiene and Epidemiology (NIHE)
Viet Nam

Dr John McCauley
Director, WHO Collaborating Centre for Reference and Research on Influenza, National Institute for Medical Research
United Kingdom

Professor A.D.M.E. Osterhaus
Head, Institute of Virology, Erasmus Medical Center
Netherlands

Dr Malik Peiris
WHO H5 Reference Laboratory, Department of Microbiology, University of Hong Kong
Hong Kong Special Administrative Region of China

Dr Vivi Setiawaty
Head of Virology, National Institute of Health Research and Development (NIHRD)
Indonesia

Dr Yuelong Shu
Director, WHO Collaborating Centre for Reference and Research on Influenza, Chinese Center for Disease Control and Prevention
China

Professor Jerome Singh
Head of Ethics and Health Law, Nelson R. Mandela School of Medicine
South Africa

Dr Masato Tashiro
Director, WHO Collaborating Centre for Reference and Research on Influenza, National Institute of Infectious Diseases
Japan

Dr Trihono
Director General, National Institute of Health Research and Development (NIHRD)
Indonesia

Dr Philip Van Dalen
Cluster Coordinator, Infectious Diseases, Ministry of Health, Welfare and Sport
Netherlands

Dr Richard Webby (not present 16 February 2012)
Director, WHO Collaborating Centre for Studies on the Ecology of Influenza in Animals, St. Jude Children's Research Hospital
United States of America

Branswell On the CFR Of H5N1

 

 

Credit CDC PHIL  - BSL-4 Lab Worker

# 6143

 

 

Yesterday we saw an article in Nature by Declan Butler that looked at the evidence (for and against) a high CFR (case fatality ratio) for the H5N1 virus (see Declan Butler On the CFR Of H5N1).

 

This, as you probably know, has been a major topic of debate in recent weeks as the controversy over H5N1 research in ferrets roils on. Some researchers maintain that the virus is not nearly as dangerous as others have portrayed.

 

Helen Branswell weighs in with her own highly informative piece, which appears in Scientific American today. 

Follow the link to read:

 

Dread Reckoning: H5N1 Bird Flu May Be Less Deadly to Humans Than Previously Thought--or Not

Are fears of human-to-human transmitted bird flu overblown or does it make sense, based on current fatality rates, to anticipate a worst-case scenario for a future outbreak of H5N1 flu?

By Helen Branswell  | February 14, 2012

Nature Editorial: Facing Up To Flu

 

BSL-4 Lab Worker - Photo Credit –USAMRIID

 

 

# 6130

 

Tying in with my last post (see Declan Butler: Lab flu may not aid vaccines), we’ve an editorial appearing today in Nature that calls into question the short-term benefits of so-called  `dual use’ H5N1 research.

 

Follow the link to read:

 

Nature | Editorial

Facing up to flu

Nature 482,131

(09 February 2012) doi:10.1038/482131a

Published online 08 February 2012

The potential for mutant-flu research to improve public health any time soon has been exaggerated. Timely production of sufficient vaccine remains the biggest challenge.

(Continue . . .)

 

 

I expect that we’ll see vigorous counterpunching on this issue in the not too distant future as both sides prepare for the meeting in Geneva next week.

 

Stay tuned.

 

The stakes here are extraordinarily high, the issues are complex, and I expect no shortage of fireworks.