Thursday, February 24, 2005

Influenza and bioterrorism: a note of caution commented recently that the blogosphere is about dialog. I couldn't agree more. So here is an attempt to contribute to the conversation. Recently Recombinomics, Laurie Garrett and Philalethes over at Bouphonia have commented on the question of influenza and bioterrorism, a subject I believe was first raised by Henry Niman at Recombinomics (see posts here and here) in connection with the unexpected appearance of WSN/33 sequences in Korean swine influenza reported to GenBank in October of 2004.

Before this topic goes much further, let me sound a note of caution. Bioterrorism is an issue in this instance only because it shows that the huge amount of time, effort and money fed willy-nilly into the bioterrorism maw has bought us little of real substance. But it is not the main issue or even close to it, as I shall argue below. I have real discomfort raising the flag of bioterrorism whenever it suits us to raise the visibility of a problem. If we are going to beat up on public health officials and their political bosses (and we should when we see the need) it should be for the right reasons. This was an alarming episode, not because it revealed a chink in our bioterrorism armor (armor which doesn't exist and probably cannot exist), but because it raises the alarm about surveillance and our preparedness for influenza and other emerging infectious diseases. If the WSN/33 sequences in Korean swine escaped notice by everyone but the sharp-eyed Henry Niman, even in the midst of world-wide concern over pandemic influenza, then this is a genuine problem, but a problem about influenza, not bioterrorism. I commend Niman for alerting us to the problem, but I think raising the terrorism bogeyman in the process is not the right way to do it.

Let me quickly sketch my argument. The kind of sophisticated molecular biology we are talking about isn't done in an apartment in Hamburg or a ranch in Montana. It involves advanced technical expertise and sophisticated equipment. The experiments are not likely to work immediately, if ever, as any graduate student in molecular biology is only too aware. Terrorists have far more numerous "soft" targets and ready weapons at hand. Why would they bother with a long shot like this? Explosives are their weapon of choice and explosives spread more than enough terror. So a terrorist development of influenza as a bioweapon doesn't make any sense nor is it likely to succeed. Only a state-sponsored bioweapons effort could do this. But for the same reasons we are concerned about protecting ourselves against it, any state would have to worry about the "blow back" on their own troops or population. They could much more easily and successfully use one of the more likely agents like tularemia, Q fever or anthrax. They have no incentive to start an influenza pandemic. It doesn't make sense as a bioweapon in this case either, which is why the virus is not one of the Category A agents (nor should it be). This is not to say this couldn't have happened from a lab accident or even be the kind of clerical error WHO claims it to be. Lab accidents are worrisome. But these kinds of accidents proliferate with the proliferation of "anti-bioterrorism" research laboratories. And clerical errors or deliberate dysinformation could produce extremely difficult issues of another kind connected with our very concern for bioterrorism, as Laurie Garrett has so rightly suggested.

This is more than a quibble about words. Talk of bioterrorism itself has had a baneful effect on public health. The billions in federal dollars poured into the public health system has had the effect of severely rearranging and distorting priorities, to the point where routine public health activities are suffering severely. Recently I heard a public health leader describe "bioterrorism preparedness" as a cancer hollowing out public health from within. I couldn't agree more.

Bird flu on its own is a major public health problem looming on the horizon. We don't need to mix it with questionable issues that have the unintended consequence of hurting public health.