Andrew T. Pavia, MD
Pavia AT. Laboratory Creation of a Highly Transmissible H5N1 Influenza Virus: Balancing Substantial Risks and Real Benefits. Ann Intern Med. 2012;156:463-465. doi: 10.7326/0003-4819-156-6-201203200-00386
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Published: Ann Intern Med. 2012;156(6):463-465.
Controversy erupted when influenza researchers announced that they had created an H5N1 influenza virus that was transmissible between ferrets. The controversy escalated when the National Science Advisory Board for Biosecurity (NSABB) recommended that the work be published but recommended significant voluntary redactions. The responses to the NSABB action and to the research itself have been polarized. A readily transmitted H5N1 virus could be extraordinarily lethal; therefore, the risk for accidental release is significant, and deliberate misuse of the data to create a biological weapon is possible. However, the knowledge gained by these and future experiments under appropriate safeguards is likely to allow critical understanding of influenza transmission and virulence. It would be irresponsible to adopt either extreme solution: to prevent and censor the research or to allow unlimited distribution without careful review by an independent group, such as the NSABB.
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Benjamin E., Rosenstein, Graduate Student
University of Minnesota-Center for Bioethics
April 4, 2012
Risks and Benefits of H5N1 Research
To the Editors:
The reviews given by Inglesby (1) and Pavia (2) are a welcome and enlightening discussion regarding the dissemination of research on the H5N1 influenza strain. Their articles are a needed change from the divided, intense, and passionate debate about this conundrum. Many contend that the scientific community should be responsible for self-regulation of the new research on H5N1 since government intrusion could lead to a "slippery-slope" of governmental control of free scientific endeavors. In publishing these reviews, I believe it is apparent the scientific community is truly attempting to self-regulate while also discovering what may be too much and too dangerous to publish even among ourselves.
Such a balanced approach is needed since creation of this virulent and possibly humanly contagious strain has raised many fears concerning biosecurity, accidental release, and purposeful terrorism which have hidden the potential benefits. Embedded in these fears is the knowledge that if, and when, such a strain leads to a pandemic, humanity is unprepared to provide the immense amount of care for the number of people such a lethal strain could infect and kill (3). Nor are we prepared for the interruption of usual daily living, and in turn our economy, which would be caused by a major pandemic (3). We learned from H1N1 that in a future, more severe pandemic, the disparities of care in our social structure could cripple not only the population in general, but especially many minorities to an unprecedented degree (4). The knowledge gained about the mutation in H5N1 could have benefits in making wider public health preparations in advance such as: preparing to manufacture vaccines, increasing ventilator accessibilities, and expanding primary care facility and personnel access. This type of research has led to new territory which reminds us that research not only expands our scientific knowledge but also expands of our responsibilities to our society.
1. Inglesby, TV. Engineered H5N1: A Rare Time for Restraint in Science. Ann Intern Med. 2012 March 20;156:460-462 [PMID: 22282173]
2. Pavia, AT. Laboratory Creation of a Highly Transmissible H5N1 Influenza Virus: Balancing Substantial Risks and Real Benefits. Ann Intern Med. 2012 March 20;156:463-465 [PMID:22282172]
3. Vawter DE, Garrett JE, Gervais KG, Prehn AW, DeBruin DA, Tauer CA, et al. For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic. St. Paul, MN: Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics; 2009. Accessed at: http://www.health.state.mn.us/divs/idepc/ethics/ethics.pdf on 30 March 2012
4. Debruin D, Liaschenko J, Marshall MF. Social justice in pandemic preparedness. Am J Public Health. 2012; 102(4):586-591. [PMID: 22397337]
Infectious Disease, Influenza.
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