Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr Jessica Vitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
Two leading scientific journals have been asked not to publish details of research into the deadly bird flu virus. The research involved creating a highly transmissible version of H5N1. The scientists hope to gain valuable data that could lead to a vaccine. But the National Science Advisory Board for Biosecurity said the experiments, if made public, could be used by bioterrorists. Their decision raises many questions – including should the scientists have created the deadly new variation in the first place. Join us to discuss whether publishing research into virulent diseases is a threat or a benefit to public health.
- Bruce Alberts Science editor-in-chief
- Ruth Faden Director, Johns Hopkins Berman Institute of Bioethics;
- Dr. Anthony Fauci director of the National Institute of Allergy and Infectious Diseases/NIH.
- Dr. Michael Osterholm Director of the Center for Infectious Disease Research and Policy and Director of the NIH-sponsored Minnesota Center of Excellence for Influenza Research and Surveillance Board member, National Science Advisory Board on Biosecurity
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Scientists working here in America and in the Netherlands on a variation of bird flu have been asked by the federal government not to publish their results. This unprecedented request has raised concerns over how we balance scientific progress against public safety. Joining me in the studio, Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases and Ruth Faden from John Hopkins University's Institute of Bioethics.
MS. DIANE REHMAnd from KQED in San Francisco, Bruce Alberts from Science magazine. On the line with us from Minneapolis is Michael Osterholm from the Center for Infectious Disease and Research Policy. We'll be happy to take your questions and comments. Join us on 800-433-8850. Send us your email to email@example.com. Join us on Facebook or Twitter. Dr. Fauci, tell us about the work that the researchers were doing and why it's become so controversial.
DR. ANTHONY FAUCICertainly, Diane. The subject matter is the potential pandemic influenza virus H5N1 that we all know -- in fact, we've discussed this on this program -- has been circulating predominantly in Southeast Asia first in 1997, went under the radar screen. Then from 2003 to today, it's still a smoldering there. It's a particularly virus. It is referred to sometimes as the bird flu. It kills chickens. It disseminates -- it decimates flocks.
DR. ANTHONY FAUCIIt has the characteristic -- it doesn't spread very well at all from chicken to human. There've only been about 600 cases. And it doesn't spread at all with very few exceptions from person to person. The bad part about all of this is that it has a high degree of lethality. They have been over 300 deaths. So although it doesn't spread well, it is a very highly lethal virus. It has adapted well to the chickens but not to the humans.
DR. ANTHONY FAUCIThe thing that is causing continual anxiety over the years particularly in that area of the world -- but in anywhere in the world because as we know, flu spread very, very well when they have the capability of spreading -- is what are the characteristics of this virus? Can it or will it ever adapt itself to a human so that it will spread at the same time as maintaining its high virulence or its lethality?
DR. ANTHONY FAUCISo we need to be able to have a mechanism whereby we may be able to track: Is it evolving to do better in transmissibility? What would be its characteristics so that the people in the field who are there doing the surveillance can get a head start on seeing what it might look like if it starts to assume these characteristics? In addition, if it does mutate to the point naturally where it does spread well from human to human, is the vaccine that we made several years ago gonna induce a response that would be protective?
DR. ANTHONY FAUCIWould it still be sensitive to the drugs? So the research that was done was to take a virus and use in the best animal model we have, a ferret -- not an absolutely great model but the best we have -- to indicate that if you make some mutations, which historically have been known to be associated with increased transmissibility, and then passage them in ferrets, can you prove the concept that you can actually make it more transmissible? And if so, what are its characteristics that would alert health officials that this might be on its way?
DR. ANTHONY FAUCIThese experiments were done. A virus was made by certain types of mutations and passages, and this is something that is a clear public health importance for scientists. But in the development of the virus, it's clear that it is possible, not certain, but possible that this virus might actually be able to made by people who have nefarious various motives and might be able to be spread on society.
DR. ANTHONY FAUCISo with the balance between the scientific need to know so that we could help protect society and then also not getting it into the hands of everyone and anyone who, in fact, might have a nefarious motive, the balance being we wanna make sure we get it into the hands of the scientists, the public health officials who need to know that knowledge, and they need to know the details of the knowledge.
DR. ANTHONY FAUCIBut certain people, according to the recommendation of the advisory board, really shouldn't have access to that. And that's the real question that's being discussed right now.
REHMDr. Anthony Fauci is director of the National Institute of Allergy and Infectious Diseases at NIH. Michael Osterholm, you're a member of the National Science Advisory Board for Biosecurity. Can you explain why the board was so worried about publishing full details of this research?
MR. MICHAEL OSTERHOLMWell, first of all, Dr. Fauci did a very nice job of laying out the issue...
REHMI thought so, too.
OSTERHOLM...in the fact that we're really talking about here is how do we move forward with very important information that policymakers as well as scientists need to know in terms of the risk that H5N1 poses as a naturally occurring pandemic strain. These data surely support that that could happen. But as you pointed out, our concern is how do we inform scientific community without putting this information readily into the hands of those who might use it for nefarious purposes or even someone who just wants to try to work with this virus and has a laboratory accident or a safety issue.
OSTERHOLMAnd so what we were trying to do is balance this, you know, censorship is really one of the original sins of research. We don't wanna censor it. It never should be censored. This is important information to get out. We don't want to readily make it possible for someone who today, with the kinds of microbial genetic tools we have in laboratories, where people with much less sophisticated training can do things that would, in fact, be like what was done here, we don't want that to happen. So we're trying to balance this, and we don't have the final answer. The National Science Advisory Board for Biosecurity was very clear.
OSTERHOLMThis requires an international dialogue between scientist, those in policy positions, those who deal with security information and those who, in an everyday basis, run the frontlines of public health. So we don't expect that this discussion is done at all. It's just beginning. But in the meantime, you can't unring a bell. So what we don't wanna have happen is some of this information get out there in a way that we regret that it's getting out there, and that's what we're trying to do is be cautious, careful, but move as quickly as we can forward.
REHMBut, Michael, explain to me what the statement from the National Science Advisory Board actually means and how you will balance the needs of society versus the risks involved.
OSTERHOLMWell, first of all, let me make it real clear. The National Science Advisory Board for Biosecurity is just an advisory board to the U.S. government. It has no legal standing in the sense of being able to enforce any of its recommendations. And so all we can do is recommend to the U.S. government what we believe is the prudent approach to take, which the U.S. government did accept that recommendation. Second of all is what we basically said is that it is important for this information to get out.
OSTERHOLMThe world needs to know what's happened, and of course, it's already out in a sense before it was ever published that this is occurring, very fact that we're on this show as a testament to that. But what we were saying is at this point, do not provide in great detail the actual mutations, the process, the final results. Now, the study has been presented publicly in at least one meeting, but all the data wasn't presented. It really gets down into -- you might say the nuts and bolts of what was done.
OSTERHOLMAnd so what we're saying is provide this basic overview kind of presentation, and then there needs to be this immediate series of meetings between public health officials at international level, between government policy persons involved with health policy and security immediately. And so we are trying to help foster that. We also are working closely with the two editors. I know Dr. Alberts here on the phone and the editors at the other journal or the other paper has been submitted nature. We're trying to work with them to find the best short-term, intermediate and long-term ways of dealing with this.
REHMAll right. Michael Osterholm is a board member of the National Science Advisory Board on Biosecurity. And to you, Bruce Alberts, how unprecedented is this request?
MR. BRUCE ALBERTSThis, in biology, is a completely unprecedented, Diane, and it -- because of that, we want to set a good precedent. It's gonna be a new precedent. And it's a very serious issue because, of course, the way science advances is that you publish not only what you found but how you did it so other people could build on your work. In this case -- and this is the first time this has ever happened because the advisory board has considered numerous other cases -- we've been asked to redact the information.
MR. BRUCE ALBERTSAnd we need, however -- and the editors are pushing back at the government to make them establish a clear, transparent mechanism, whereby those who do have a need to know can get this information. The fact is that, you know, this is the U.S. government. The real danger here is not in the United States . It's in places like Indonesia and China, where the immediate danger is -- the virus already circling back and forth between birds and people.
MR. BRUCE ALBERTSAnd, of course, we have to make sure that the people on those countries have access to this information. And it has bothered us that the NSABB and the government had not previously worked out a clear mechanism, and this precedent -- one of the things we're doing in this precedent is setting a clear pathway for information that is needed to get out there. And basically, the journalists have been insisting that this mechanism be announced at the time that we actually publish the abbreviated manuscripts.
REHMSo from your point of view, this is not only unprecedented, but I gather you are concerned about more situations like this arising in the future. Bruce Alberts, he is Science magazine's editor-in-chief. We'll take a short break here. When we come back, we'll speak with Ruth Faden of the Johns Hopkins Institute of Bioethics.
REHMWelcome back. We have four guests with us, two here in the studio: Dr. Anthony Fauci of NIH and Ruth Faden of the Johns Hopkins Institute of Bioethics, as we talk about the latest experimentation on H5N1, the bird -- so-called bird flu and the latest experimentation, which is not going to -- at least has been recommended that it not be published in full. Turning to you, Ruth Faden, I wonder how you respond to the perceived threat and whether it does outweigh the right to publish.
MS. RUTH FADENI think the key consideration here is exactly as Dr. Alberts phrased it. We need to use this as an occasion to prevent ever being in this situation again. It shouldn't be that we're at this point where there is so much information, it seems, already circulating about these experiments, considering how we're going to manage the risk that this advance in science represents.
MS. RUTH FADENI'd like to hear from my colleagues on the panel, but I believe that it could've been anticipated that had these experiments been successful, that had this line of research, in fact, accomplished what was intended, that we would be at this point at the time that the results were coming in. And so the key issue, I think, is to recognize that we, it's true, have a clash between our national security -- global security, actually, interest and our public health and scientific objectives.
MS. RUTH FADENBut in the end, we're talking about the same thing. We're all about reducing the probability that we'll be a facing a killer pandemic, right? Both communities, national security and science, are worried about the same thing. And the key consideration is how, in prospect, to identify experiments, lines of research that could put us in this situation, and then work globally, as several of the other members of the panel mentioned on the show already, to anticipate and to figure out ways to manage the risk so that the right people do have access to the information, and we minimize the probability that the wrong people do.
REHMHow can you -- if this information is, indeed, published globally, how can anybody prevent the wrong people from getting hold of it?
FADENIt's a staggering problem, but it also is tractable. I mean, it can be managed. We manage risks all the time, and we have other models where information has to be carefully made available to the right people under the right circumstances. The problem for us in biology is that this is such a new phenomenon, and it runs counter to the way in which we understand the value of information. Science thrives, you know, centrally on the free flow of information on transparency and on openness.
FADENSecurity concerns often have the opposite view about information. It's to be held close and to be revealed carefully. And we're walking an interesting line here between those two.
REHMBruce Alberts, I understand that this is indeed a recommendation from the National Science Advisory Board. So how much of a debate is going on within Science magazine as to whether to accept or reject this recommendation?
ALBERTSI think, Diane, it's good to back up a bit because right after 9/11, the academy set up a committee. it produced a report about what to do in these kinds of situations because we knew they'd be coming. The report is colloquially known as the Fink Report because it was chaired by the distinguished scientist at MIT Gerry Fink, a member of the academy. And this committee had a mixture of outstanding scientists and security experts on it.
ALBERTSAnd one of their prime recommendations to go forward was to set up this advisory board that we're now dealing with. And to move these kinds of decisions thereby into a group with sophisticated understanding of the science because this National Security Advisory Board for Biosecurity contains many distinguished scientists, but it also contains security experts. And I view it as the Supreme Court for making these very difficult decisions.
ALBERTSAnd I should emphasize that in previous years -- it's been seven years now this board has existed. They have never previously made this kind of recommendation. They have instead said, let it be published openly. And so there are two different aspects for Science magazine here. One is this particular issue we're dealing with here.
ALBERTSBut I think equally important is that this advisory board is the best mechanism we can imagine for dealing with these complicated issues, and Science magazine would like very much to support this mechanism. And this is a crucial moment for the whole idea of biosecurity and biology. But it's also...
REHMBut is there a but there?
ALBERTSYes. The but is that they haven't thought through the other end of this or at least they hadn't worked it through, and it's very complicated. And, you know, ideally, we have an international mechanism, but we -- all our discussions back and forth last few months have dealt with the fact that the international mechanism is gonna be -- take a long time to establish. And we are in a hurry to get this.
ALBERTSIn fact, the board says we should publish this relatively quickly so that the general information is out, and we could give the details to those who need to know. So my -- Dr. Fauci would be the best person to address this issue. But the government has been working very hard to design a mechanism that's basically centered on the U.S. government temporarily, but involves a lot of international scientists, and this is critical.
REHMOf course. Dr. Fauci.
FAUCIWell, I think Dr. Alberts really put his finger on the difficulty. This is really very complex. I happen to have been part of the group that had these deliberation years and years ago at the White House about setting up an NSABB. One of the issues is that despite the fact that this was -- been going on for some time, it has been very difficult for the NSABB -- and I'll finish, but I would also like to hear from Dr. Osterholm, who's a member of the NSABB.
FAUCIIt has been very difficult because of the complexities of science and scientific information and freedom of pursuing scientific leads for the board to come up with some very strict definitions that would leave the free floating undifferentiated capability of scientist to pursue their lead, let -- don't interfere with scientific freedom, don't interfere with the ability to do what Dr. Alberts said in the beginning, 'cause the very nature of science is to do experiments, to disseminate the information, to get it replicated, to get it confirmed to go to the next step.
FAUCIThere has been an appropriate great deal of sensitivity on the part of the board about making sure you have the delicate balance and it is correct. It would've been wonderful if all of these things were in place right now. But one of the issues is that sometimes when you start an experiment or you go down the path...
REHMYou don't know where it's going.
FAUCI...you don't know where it's gonna go. So on the one hand, when it comes to dual use, that's a concern. When it comes to pure science, that's the beauty of science, not knowing where you're going or what result. And also part of the importance of it is being able to disseminate it. So one of the things that -- and I agree with everything we've said about having to make sure we have now -- this is gonna trigger a very intense dialogue.
FAUCISo this is gonna be the catalyst to do the kinds of things that really we need to have done. But even with that, it is not gonna be very easy to do because the concern that all of us as scientists have that you put into place such a strict constraints on things that you would have the end result of the impediment not only of the science itself but of the dissemination of the science. And I believe that's one of the reason why the NSABB has had such a difficult time in coming up with some very strict guidelines.
REHMSure. Ruth Faden.
FADENI was a member of the Fink committee that Dr. Alberts was referencing, and I think that some of the recommendations of that report that were not taken up are still now extremely worth reconsidering. We have other models in place that have been -- one other model in particular that has been in place for a long time to protect against the very low probability that a scientific experiment could produce catastrophic outcome for society, and that's an oversight committee looking at recombinant DNA research.
FADENIt's been in place for a very long time, and it has been very successful at balancing exactly the ways in which Dr. Fauci has called for balancing to occur. I think, by and large, the scientific community has felt that the work of that group has been very, very balanced. Almost all of the science has been permitted to go forward, and the work has not been impeded in any way.
FADENThus, a mechanism like or that mechanism expanded, could be considered, it could be absorbed into the NSABB. There are prospective options as well as retrospective options that we can, I think, seriously take into account and that this particular experience underscores the importance of pursuing.
REHMSo are you saying, Ruth Faden, that you think that the decision of or the actions of the National Science Advisory Board on Biosecurity on this particular issue have not been fully thought out or fully considered before issuing the caution and asking that details not be published?
FADENI am not clear about the timing, but my sense or my understanding of the fact situation is that the NSABB did exactly what it should have done, given that it was presented with an after-the-fact situation. It's my...
OSTERHOLMYeah, I think, Diane, it's really an important point here to raise the circumstances in which we're operating. First of all -- and Dr. Faden very appropriately laid out the fact -- it would have been nice if we had anticipated this. But I'm one of those few researchers in the world that is both very deeply into the influenza world and also into the bioterrorism world in terms of research and public action.
OSTERHOLMAnd I can tell you that we still don't understand why the 1918, the 1957, the 1968 or the 2009 pandemic strains emerged. We can't go back and do a forensic investigation and tell you this was a genetic change that made those strains go from being non-pandemic to pandemic viruses. So none of us really put the H5N1 experimental work on that high level of radar concern because we still don't understand why.
OSTERHOLMSo how could we invent a basic pandemic 2012 H5N1? Now should we have thought about that? But based on the evidence we didn't think about it, we're there, and the bottom line is we're there. But I think one thing that's missing from this discussion is because I deal with all these other bio-agents, I can tell you whether it's smallpox, Ebola, SARS. I don't care what it is.
OSTERHOLMNothing has the potential to have the catastrophic consequences of another influenza pandemic, but this time caused by an agent that could easily, based on its historic perspective and what we're seeing right now in these experiments, kill 10, 20, 30 percent of the world's population. The stakes here are so high we can't be wrong.
REHMMichael Osterholm. He is a board member of the National Science Advisory Board on Biosecurity. And you're listening to "The Diane Rehm Show." Bruce Alberts, I see you smiling out there. What's your reaction?
ALBERTSSo I have another perspective based on the fact that I've been the science envoy to Indonesia for President Obama, and so I've spent a fair amount of time in that country. I think it would be great to take a particular situation as a test case and try to work our way through it. And, you know, for example, should we publish this paper in a redacted form and not get the information to the right people in Indonesia and suppose that, six months from now, a disastrous outbreak occurs in Indonesia?
ALBERTSWhat does the United States look like? All my work in science diplomacy is out the drain. This is a serious issue for those kinds of countries that have this virus. So we have to have a mechanism to get the information out even if it's an imperfect one. The people in Indonesia have a need to know. And...
REHMAnd Indonesia, Dr. Fauci, is where an awful lot of this has occurred.
FAUCIRight. I totally agree with what Dr. Alberts says, and that's, again, my concern about any kind of inhibition on dissemination of information. The NSABB, as Dr. Osterholm mentioned, came up with this particular decision in good faith. But I think it's important for people to understand when one says, you should have anticipated this. It certainly would have been nice if the NSABB already had in place all of the mechanisms of what you do about that. And they're working right now...
REHMOr what you don't do.
FAUCIRight. They're working now on the long-range approach. And as Mike said very appropriately, this is gonna be starting an important dialogue. But when experiments get done at the institutional level, each institution has an Institutional Biosafety Committee that judges whether or not this is something that you need to be alerted to should it go forward. We don't want the federal government, in my mind, even though we do have select agents, that the NIH does not do classified research.
FAUCIWe do the kind of research that Bruce was talking about that should be openly disseminated. At the point that the experiments were begun, the judgment was made that it was OK. There wasn't an alert saying, hey, you know, wait a few years down the pike at all.
REHMHold off, yeah.
FAUCISo it was a bit of a surprise that this happened. So, I mean, I think Ruth said the appropriate thing. Maybe you should have anticipated it, but certainly at the time when this was put forth before the Institutional Biosafety Committee, it was not. Should now, in retrospect, you thought that it would have? Perhaps.
REHMNow I hope we haven't lost Michael Osterholm, but if we have, this is just to let you know we're having a little problem with our phones this morning. We'll do the best we can to take in your calls as we move forward. I wanna go back to Bruce Alberts, however, very briefly to ask if this information is published in redacted form, could there be some way of working backwards from that redacted information to create the very information you don't want out there?
ALBERTSWell, I mean, of course, anything is possible, but it makes it very unlikely. The kind of information that is going to be left out of this paper, assuming we can reach an agreement -- and I hope we can -- is information such as the exact mutations that it takes to make this very dangerous virus survivable in the air, which is how it gets to be infectious.
REHMBruce Alberts. He is editor-in-chief of Science magazine. Short break here. And when we come back, your comments, your questions.
REHMAnd I am apologetic. Our phones have not been working correctly this morning. We have lost one of our guests, Michael Osterholm of the National Science Advisory Board on Biosecurity.
REHMI know many of you have been trying to call in and are perhaps frustrated so just bear with us this morning. We'll try to get to you. Bruce Alberts, just before the break, you were talking about the question of whether to go forward with a redacted version of this scientific experiment. And then the question becomes who would get the unredacted version? Who in Indonesia or elsewhere in the world whom you feel needs the information? Who decides who gets it?
ALBERTSWe are hoping, and I think this is true -- and Dr. Fauci has been involved in this -- that the U.S. government will soon have a -- an improved plan for dealing with this critical issue. It's critical for both of the editors, both myself and Phil Campbell, who is the editor of Nature. We've been working together. And basically, it's also critical for the authors that there be a mechanism to get the information out quickly to those who have a need to know.
ALBERTSThis whole issue raises a very broad one that I've been involved in for years, the importance of building scientific capacity everywhere around the world. I know there are some Americans who thinks that, you know, are -- attempts to help other countries build a scientific capacity, you know, why should we be doing that? But this is a great example of why.
ALBERTSYou know, if Indonesia doesn't have the capacity to deal with this, to monitor the possible natural appearance of these mutations that we're gonna tell them about what we're looking for, then, of course, that raises the possibility that this very dangerous version of bird flu will come out in the wild, devastate large amounts of Indonesia. But, of course, we know that it will spread around the world.
ALBERTSSo Indonesia badly needs to have the capacity to deal with these issues in a sophisticated way. And this is, you know, we could generalize for this in many other areas, but the world depends on having strong science in every nation.
FAUCIDiane, I totally agree with what Dr. Alberts said. And what we're trying to do -- when I say we, there's now multiple parties involved because the NSABB advises not only the secretary of HHS and the NIS but also a number of other agencies, agriculture, state, et cetera, et cetera. So there's ex officio membership on that committee that goes well beyond what we consider the classic scientific community of the NIH and the CDC.
REHMOf course. Yeah.
FAUCIMy concern and what we're trying to do is to make sure that the information gets out to really the people, such as the people that Bruce mentioned. The scientists...
REHMAnd who decides that?
FAUCIThat's what we're working on right now, and I want to make sure. To the best of my capacity, though, I do not call all the shots here at all to make sure that we don't err on the side of making it really difficult for scientists to get this information.
REHMAll right. And here's a comment from Keith in Silver Spring, who says, "I see this as a very slippery slope. The government can decide that anything could be a threat and request it be withheld. The government is overreaching and maintaining fear mongering." That from Keith in Silver Spring. Ruth Faden, how do you respond?
FADENOh, I think Keith is responding in a way that lots of us can identify with. We are concerned about censorships. Censorship is inimical to the way in which we understand the relationship between the state, the government and the enterprise of science. At the same time, we're dealing with a pressing public health concern. We clearly don't want an advance in science to facilitate or make easier the outbreak of a killer pandemic.
FADENAt the same time, and this is the balance, we clearly now, with this information, have an obligation, a moral obligation, I would argue, to make sure that the public health benefit of this scientific breakthrough is made available. So we've got to get it out.
REHMAll right. I'm going to try to go to the phones now. And I think, Michael Osterholm, you're back with us. Let's go to...
OSTERHOLMI am. Thank you.
REHMOK. Let's go to Grand Rapids, Mich., and to Brian. Good morning.
BRIANYeah. Good morning, Diane, and happy holidays to everyone.
BRIANScience is such important thing. And there's an incredible show on "Nova" last night on human DNA and especially how mutations work. It's very informative. My question is this information is on a computer's drive somewhere, and how likely is it that this computer information could get hacked by evildoers to make such a devastating mutation?
REHMAll right. Bruce Alberts.
ALBERTSWell, that's -- it's certainly on the science computers which is behind many different walls. We've never been hacked before. But anything is possible in today's world. I would assume that the distribution mechanisms that the government is going to recommend would be very secure ones and taking in account these kinds of possibilities. Of course, this issue has been dealt with of getting information to selected people with a need to know in other communities, the physics community and so on.
ALBERTSSo we have a -- an experience to build on. It's not my area of expertise, but it's an important issue. I just wanna make one other point that, you know, eventually, this information will leak, and it's not -- eventually.
ALBERTSSo what we hope -- and again, Dr. Fauci is gonna be intimately involved here -- is that we will redirect resources to -- based on what we now know about this virus, dangerous virus -- potentially dangerous virus to make it clear that, you know, at least in three years, it won't make much difference because we've protected ourselves against it.
REHMHere's a comment from Steve on our website, who says, "What is sad is that once it's generally known a super flu can be produced, one of the bad guys will try to do it. And one can suspect that a good graduate student in virology will be able to do so. Limiting access to the details of how to produce it should make it a little bit harder to produce the flu, but unfortunately a super flu that gets out may well happen." Michael Osterholm.
OSTERHOLMYeah. You know, I don't know how much from my previous answer was before the phones went dead here but, again, I just wanna come back and say that the potential impact of this is so catastrophic. Anything we can do to frustrate someone or some group from doing this, even if it's unintentional, whether just working with and then it gets out, I think this is a benefit. Time is of a real critical nature here. We need to do much better in terms of making influenza vaccines and how we make them.
OSTERHOLMOur current vaccines in the past pandemic worked only a little over half of the time when we had the closest match between a virus and the vaccines that we've had in decades. And so we need to really understand that preparedness is key here. So I think that while we have this urgent need to consider getting information out there to people so they can look for this virus, my question is so what if we find it? What are we gonna do? Do we have vaccines for the world? Absolutely not.
OSTERHOLMWe had only limited vaccine available in the developed world for the last pandemic. The same thing would likely happen again. So I think that there's a number of fronts that we need to approach this with with this information. One is basically better preparing ourselves for the next pandemic. And should this be the agent, everything we will do will pay back in spades. Second of all, I think we do need to get the information out.
OSTERHOLMI would like to add one word of caution here. I think everyone is assuming that because we get this information out, we will be able to detect this virus quicker or sooner or that somehow it will tell us. As somebody who spent 35 years in the ground doing infectious disease surveillance, I'm not sure that's the case.
OSTERHOLMWe don't know that this combination of mutations are the ones that will make the next pandemic strain. They can make a pandemic strain, potentially. So we have to be a little cautious in assuming that there's a one-to-one match between getting information out, early detection and somehow changing the pandemic. But I do know getting this information out in way that allows it to quickly get into the hands of those who would use it for nefarious purpose has tremendous consequence.
FAUCIWell, I agree. And just to supplement that a bit, I think it's important for people who have the concern that is being expressed -- and this is a difficult issue, and we respect the differences of opinions here -- we must remember, historically, that on the side of getting information to scientists as easily as possible who have a need to know to continue the research that we all want to continue is to be able to counter what is the worst bioterrorist of all, historically.
FAUCIAnd that is what nature has done of the pandemics that have come around. That is the reason why it's important to have this knowledge and to get it into the hands of the people very easily who can do the experiments because there's an infinitely greater likelihood that nature itself will cause great harm by the emergence of new infections and re-emergence of old infections than it is that someone will deliberately perpetrate that.
REHMWell, now, Dr. Fauci, you know as well as I do that there had been questions raised as to whether you might have a rouge scientist, for example, who decides to use the information to do exactly as everyone fears and create this massive pandemic. So in publishing any of this information rather than somehow getting it directly to the people who need to have it, you know, boy, that is a big balance.
FAUCIRight. It is a very difficult situation, and that's the reason why we're having the discussion here, and we have to strike the delicate balance of not making something that's obviously gonna be easy for somebody to do harm with versus putting constraints on the open scientific interchange, which is the fundamental basis of why we have so many of the important good public health countermeasures that we have available.
REHMAll right. To Gainesville, Fla, good morning, Brandon.
BRANDONGood morning. Thank you for having me.
BRANDONI was wondering if this could be handled through a more modified material transfer agreement where both the laboratory that found the discovery and the government could, you know, kind of qualify the merits of the requesting laboratory.
OSTERHOLMSurely, this is one mechanism, I guess...
REHMGo right ahead.
OSTERHOLMI think this is a mechanism we surely can look at, transfer issues. I think the point, though, is that, again, depending on what your views are of what happened with the anthrax situation -- I, for one, very strongly believe that Bruce Ivins, the researcher at Fort Detrick, did, in fact, perpetrated this event. And based on that, we even have to think about what's in laboratories. How do help police ourselves that what we know that even if there was someone who had a legitimate need to know for their work ultimately didn't decide to do something else?
OSTERHOLMAnd I think that this is where we've tried to come up with a conduct of professional behavior with this board. How do we, basically, not spy on our colleagues, but at the same time, if there are things that happened that we believe should give us a sense that something is wrong here, that we deal with that issue? And so I think that there's never gonna be a perfect answer. Even if it gets to the right people, it doesn't mean that the right people are always gonna do the right thing.
REHMAnd you're listening to "The Diane Rehm Show." Anthony Fauci.
FAUCIWell, one thing also that people need to understand that the H5N1 is considered a select agent. And when something is a select agent, that means that people that are allowed to work within -- and if you look at the experiments that were done, they did an experiment on the particular H5N1 virus that has been articulated by the scientists and by others and maybe sometimes not heard.
FAUCIBut that people who work on these types of agents have to be well trained. They have to have the proper secure facilities. They have security checks and all things like that. So it isn't as if to -- somebody could now go out in the wild, get this virus and immediately start working on it or get a material without having to go through a lot of clearances.
FAUCIYou're never gonna have an absolute 100 percent block against people who might do nefarious things (unintelligible) the anthrax issue. But in the balance of thing, I think when you look at the benefits of doing these types of research, the benefits far outweigh the risk.
REHMAnd do you agree with that, Ruth Faden?
FADENI actually do agree. I agree completely. We are not a zero-risk culture. We have to assume some level of risk when we're pursuing something of great importance. The question is, do we have the mechanisms in place to assure that we are properly assessing the benefits and risk and that we have the plans to manage the risk?
REHMAnd I think Bruce Alberts wants to comment.
ALBERTSI like to ask Tony a question, which is very much on my mind. I mean, how does this new discovery change the way we think about focusing research dollars, down the road, on these issues, or does it?
FAUCII don't think, Bruce, that it's gonna have a major impact on deliberately steering funds one way or the other. You know, there were several reasons to do the experiment. The entire concept of if you do have a change that would increase transmissibility while maintaining virulence and lethality, you know, what does that look like? People are gonna be putting grants in to study that. And I think it should be studied.
FAUCIWhat impact does this have on sensitivity to any virals? Are the antibodies that were induced by the original H5N1 vaccine that we developed, does that neutralize this virus? Do we need to do a little bit better? There are a lot of good questions that come up. And as you know, Bruce, as the editor of Science, better than anyone, when people put in grant applications to study these very important problems, if they are peer reviewed in a way in which it looks like there's something that is important to do and a good qualified scientific proposal, it will get funded.
REHMBruce Alberts, do you believe that it's really possible to develop a workable mechanism whereby work like this -- research like this can be shared with the people who need it without running a security risk?
ALBERTSWell, I think we have to do this. I mean, there's no way not to share it. It would be an absolute disaster for the world if an epidemic -- pandemic breaks out in one of these countries, and it could have been prevented by the kind of knowledge that we are not publishing. And this is -- this would be the worst of all possible worlds. I think what we -- hopefully what's gonna happen is that we will go ahead in this -- set a precedent here. The government will have a mechanism, and we will study both what we did and the mechanism. And the next time, we will have even better mechanism.
REHMAll right. And we'll have to leave it right there. Bruce Alberts, Science magazine editor-in-chief, Michael Osterholm of the National Science Advisory Board on Biosecurity, Ruth Faden of Johns Hopkins Institute of Bioethics and Dr. Anthony Fauci of NIH, thank you all. Clearly, a conversation is going to continue. Thanks for listening, all. I'm Diane Rehm.
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