Report on Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
The term “biosecurity” is often used ambiguously, and its precise definition depends on who you ask. An unpacking of the term reveals a number of distinct concerns: For some, “biosecurity” primarily involves preventing the accidental release of an engineered pathogen from a lab; for others, it means keeping dangerous information and biological materials out of the hands of would-be terrorists; and for others still, it involves the development of medical countermeasures to fight the next pandemic, no matter the origin. The myriad meanings attributed to the term “biosecurity” reflect the complexity of the risk to public health posed by developments in biology––and from this complexity arises an amalgam of possible responses, necessarily engaging multiple sectors of society.
Given the multifaceted nature of the challenge of biosecurity, any meeting of minds to discuss it would be incomplete without input from a diverse set of perspectives. The Summer Workshop on Pandemics, Bioterrorism, and Global Health Security, which was hosted by the Schar School of Policy and Government at George Mason University and which I attended in July, was held in strong recognition of this fact. The organizational affiliations of the participants were remarkably varied. Participants came from the Department of Health and Human Services (HHS) and the Department of Defense (DoD); from gene synthesis companies and medical countermeasure suppliers; and from national labs and universities. There was a strong representation of both public health- and national security-oriented perspectives.
The Schar School of Policy and Government at George Mason University.
Dr. Franz presenting on DURC regulation.
Dr. Franz presenting on DURC regulation.
The workshop spanned three days and consisted of three two-hour lectures per day, each accompanied by an extensive reading list and presented by speakers who in some cases have been thinking about biosecurity-related issues for decades. A number of the talks focused on different types of possible responses to biological threats. For example, Dr. Dave Franz, a former member of the National Science Advisory Board for Biosecurity, presented an overview of the US government’s regulatory responses to dual-use research of concern (DURC), or life sciences research that could potentially be misused with significant negative consequences. Dr. Franz emphasized that while some amount of regulation is necessary to oversee the conduct and publication of DURC, regulation comes with the price of hampering legitimate life sciences research and is unlikely to be sufficient to contain the risks of DURC moving forward. Developing a culture of responsibility among life scientists was presented as a complementary solution, being less likely to impair the relationship between scientists and the government than burdensome regulation.
Dr. House on new medical countermeasures.
Dr. House on new medical countermeasures.
While Dr. Franz’s talk focused on policy solutions to mitigate biological risks, Dr. Robert House focused on technical solutions in his talk on the current state of medical countermeasure development. Although still widely used, live attenuated and inactivated vaccines are old technologies whose utility against novel biothreats may be limited given the lengthy development and manufacturing times often associated with them. Dr. House was more optimistic about the potential for newer innovations such as self-replicating RNA vaccines and vectored immunoprophylaxis to serve as platforms for medical countermeasures that could be rapidly developed and manufactured after an outbreak.
Responses to biological threats, whether policy-oriented or technical in nature, are never formulated or implemented in a vacuum. Rather, they are necessarily influenced by a number of factors, including public opinion and narrow organizational priorities. That was the lesson implicit in policy analyst Sanford Weiner’s presentations of a series of case studies, which revealed how these factors can impair institutional decision-making in the face of a perceived public health crisis. For example, the rushed polio vaccine distribution effort in 1955, which eventually had to be halted after it was found that live virus was contaminating certain batches of the vaccine, was in part a result of high public expectations built up by aggressive promotion by the National Foundation for Infantile Paralysis. In 1976, despite little evidence that a new strain of H1N1 would result in a pandemic, public health authorities in the US recommended a mass immunization effort anyway, in part due to their perception that public health was undervalued and that this was their chance to make history by stopping a potentially 1918-like flu in its tracks. The immunization campaign turned out to be wholly unnecessary and resulted in a loss of public confidence in the CDC. These episodes––in addition to the more recent responses to a perceived potential avian influenza pandemic in the 2000s, to the 2009 H1N1 pandemic, and to the recent Ebola and Zika outbreaks––have highlighted the challenge of formulating an appropriate reaction to public health emergencies under the constraints of public pressure and limited organizational outlooks.
Dr. Koblentz on biosecurity as a "wicked problem."
Given that the collision of different stakeholder priorities has often resulted in suboptimal responses to biological threats in the past, how can we more satisfactorily respond to biosecurity challenges in the future? This question permeated the last talk of the workshop, presented by Dr. Gregory Koblentz. According to Dr. Koblentz, biosecurity is a “wicked problem,” i.e., a dynamic problem that can never be claimed to be completely solved, and whose contours are often defined differently by different stakeholders (e.g., by public health or national security agencies). Dr. Koblentz presented a number of more- and less-fruitful strategies to deal with wicked problems, as well as examples of how each of these strategies has been executed in the biosecurity space. Often, as was the case in the collaborative effort between government and industry to set up the International Gene Synthesis Consortium for the screening of gene orders, the most successful strategy involves collaboration between stakeholders to generate a shared commitment to solving the problem, requiring intensive dialog between stakeholders so that each can understand others’ concerns.
The Summer Workshop on Pandemics, Bioterrorism, and Global Health Security was a testament to how such communication between stakeholders can be effective, as it brought together participants from a diverse set of backgrounds to discuss a multitude of difficult biosecurity-related issues. While speakers often mentioned how the isolation of different perspectives on how to confront biosecurity challenges has led to needless conflict in the past, the environment of the workshop itself provided a clear contrast to that historical backdrop, as participants with different backgrounds frequently interacted in lively discussions. Hopefully, the collaborative model exemplified by this workshop will become the default strategy in future discussions around biosecurity. At the very least, the organizers of the Summer Workshop will continue to promote the collaborative model by bringing together participants of different backgrounds year after year. The next one will be in the summer of 2019; you can keep up-to-date at The Pandora Report.