Without an internationally standardized approval process to guide countries in conducting public health-related experiments, resurrecting an eradicated disease in the lab increases the risk it could be used as an agent of bioterrorism, says Dr. Tom Inglesby, who is recognized worldwide in the fields of public health preparedness, pandemic and emerging infectious disease, and biological threat response and prevention.
“Very high-risk work has potential international implications if it’s reviewed by national regulatory authorities lacking international norms or guidelines to direct them because it could potentially be approved by one country, but rejected by others,” said Inglesby, CEO and director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.
Specifically, Inglesby was referring to the lab synthesis of horsepox earlier this summer by Canadian researchers at the University of Alberta, who recreated the extinct cousin of the smallpox virus with intentions to possibly treat cancer, develop a vaccine for smallpox or just to show that synthesizing horsepox de novo (reviving it) was possible.
“My concern with the synthesis of horsepox, and publication of related research, is that they will lower barriers to de novo smallpox synthesis. And if the bar is lowered for creating smallpox, then that creates international biosecurity and biosafety risks because smallpox is one of the world’s only eradicated diseases,” Inglesby, a professor in the Bloomberg School of Public Health’s Department of Health and Engineering, told Homeland Preparedness News in a recent interview.
The highly lethal smallpox virus is unique to humans; there is no other animal or insect vector. The virus was responsible for killing hundreds of millions of people in the 20th century, and caused blindness, other illnesses and disfigurements for millions more before the World Health Organization (WHO) successfully coordinated a ring vaccination effort after World War II, stopping its spread. The World Health Assembly declared smallpox eradicated in 1980.
“The eradication of smallpox was one of the world’s great public health triumphs,” Inglesby said. “It is no longer circulating on the planet and people no longer have to be immunized against it.”
At the time, the WHO also recommended that every stock of smallpox be destroyed except for two viral stocks, one at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, the other at Russia’s VEKTOR research laboratory.
However, bioterrorism and other ongoing threats to public health for more than a decade have heightened concerns among experts like Inglesby, who think a rogue nation or leader could reincarnate such diseases by stringing together segments of their DNA and then misuse them to unleash biowarfare.
“If smallpox was deliberately or accidentally released, the increased risk should be of international concern,” said Inglesby, whose current work at Johns Hopkins’ Center for Health Security is aimed at finding ways to protect people from the consequences of epidemics and disasters.
And the world is ill-prepared to deal with a full-on smallpox pandemic, he said.
“There have been a lot of gains in the last 15 years, but recent Zika and Ebola outbreaks prove there’s still a lot of fragility in the world,” Inglesby said.
Myriad experts agree that while countries should have the capabilities in place for treating victims and stopping widespread infection, well-organized oversight of pathogens is lacking, this despite the ability of smallpox or a modified orthopox virus to cause millions of deaths. Some experts, in fact, think public health policy has simply relied on the unavailability of a virus rather than preparedness to guide efforts.
But as the Canadian researchers have proven with their horsepox work, the availability situation has changed.
It’s time for the United States government “to develop some rules of the road for internationally managing biological research,” advised Inglesby.
He advocates for the P3CO policy published in January by the Obama administration as a good step toward future U.S. policy development for experiments involving potential pandemic pathogens, even though the document is meant to serve only as guidance for federal agencies and doesn’t require any action on their part.
“So even as the U.S. has spent a substantial amount of time considering these kinds of issues, it still doesn’t have policy (or high-level review committees) that directly considers experiments” like the Canadian horsepox research, Inglesby wrote in an online blog last month.
The P3CO policy also contains no international component, he said, though there clearly needs to be one.
“We need agreed upon norms that will help guide countries and their scientists regarding work that falls into this category, and high-level dialogue regarding the necessary role of scientific review, guidance, and regulation for work that falls into special categories of highest concern,” said Inglesby. He also serves as chairman of the Board of Scientific Counselors in the CDC’s Office of Public Health Preparedness and Response, and chairman of the National Advisory Council of the Robert Wood Johnson Foundation’s National Health Security Preparedness Index.
U.S. lawmakers should be encouraged to improve the nation’s ability to respond to infectious diseases like smallpox and other crises, and to also engage and ramp up international cooperation, he said.
“And it’s not clear that these considerations are now even being discussed internationally.”