What kinds of biosafety risks are associated with biotechnology research?
Biosafety risks associated with biotechnology research range widely in their severity, with plausible outcomes ranging from a mild infection of a single lab worker to a deadly global pandemic leaving more than hundreds of millions of people dead (Lipsitch and Inglesby 2014). While the frequency of dangerous accidents associated with biological research is not clear, it is clear that serious accidents have happened. A recent paper by David Manheim and Gregory Lewis documented “71 incidents involving either accidental or purposeful exposure to, or infection by, a highly infectious pathogenic agent” between 1975 and 2016, with the large majority of these incidents being accidental (Manheim and Lewis 2022). This is very likely a substantial under-estimate, as the worst-managed facilities are probably the least likely to report accidents. Moreover, scientists believe that the 1977 influenza pandemic was not of natural origin, due to its being nearly identical to a previous influenza strain that circulated in the late 1950s, as well as the fact that the majority of people who were sickened by the 1977 influenza were too young to have prior exposure to the 1950s version of the virus (Rozo and Gronvall 2015).
What is Dual-Use Research of Concern (DURC)?
The WHO defines Dual-Use Research of Concern (DURC) to be “research that is intended to provide a clear benefit, but which could easily be misapplied to do harm... It encompasses everything from information to specific products that have the potential to create negative consequences for health and safety, agriculture, the environment or national security”(WHO 2020). For example, gain-of-function research which involves deliberate modification of an existing pathogen for greater transmissibility or severity can be useful for developing better vaccines and therapeutics but can also raise the risk of a serious laboratory accident or intentional misuse of the pathogen. Similarly, when pharmaceutical researchers develop more efficient aerosolization techniques for delivering drugs deep into the lungs of asthma patients, these advances could also be misused to enhance the power of biological weapons. DURC presents substantial biosecurity challenges, as it is not always evident in advance whether the benefits of dual-use research outweigh the potential risks. Dual-use research is particularly susceptible to the unilateralist’s curse. The unilateralist’s curse arises from the fact that when scientists are asked to make decisions independently (rather than collectively), it substantially increases the likelihood of someone taking a controversial action (Bostrom, Douglas, and Sandberg 2016). This raises the risk of dangerous biological research being completed and published.
Controversial dual-use research on H5N1 Influenza and Horsepox
One of the most famous examples of dual-use research of concern was that of the H5N1 avian influenza gain-of-function research conducted by Dr. Ron Fouchier of the Netherlands and Dr. Yoshiri Kawaoka of the United States in the late 2000s and early 2010s. H5N1 is extremely transmissible and often lethal among birds. H5N1 only rarely infects humans, with those being infected generally having been in close contact with live poultry, and it does not spread easily from person to person, but it does have an extremely high human mortality rate of 60%. If the virus were to develop the ability to transmit efficiently between humans while maintaining a high human mortality rate, it could launch a catastrophic pandemic. Drs. Fouchier and Kawaoka conducted gain-of-function research that demonstrated how to achieve efficient mammal to mammal transmission of H5N1, ostensibly to better anticipate how a natural pandemic of human H5N1 avian influenza would emerge (Tu 2012).
In December 2011 the US National Science Advisory Board for Biosecurity (USNABB) initially recommended that Nature and Science, two leading scientific journals,d withhold the publication of critical methodologies, to which Drs. Fouchier and Kawaoka initially agreed. In February 2012, the WHO convened a panel of virologists and one bioethicist which recommended the full publication of research, citing its importance for preparing for a natural H5N1 pandemic. Subsequently, in late February 2012 the US Department of Health and Human Services asked the NSABB to reconvene, and upon doing so in March 2012, the NSABB changed course and recommended the full publication of the research, over the objections of one dissenting board member, a recommendation that HHS accepted. Dr. Kawaoka and Dr. Fouchier’s research was eventually respectively published in Nature and Science, respectively, although the publication of Dr. Fouchier’s research was temporarily blocked by Dutch export controls (which cover intellectual material) until he applied for and received an export license (Tu 2012).
One can identify three primary potential benefits from conducting this kind of gain-of-function research. First, it might be useful for predicting when spillover events that could cause a natural pandemic might occur. Second, it might be useful for laying the groundwork for quickly developing medical countermeasures to future natural pandemics. Third, it might be useful for attracting attention to a ticking time bomb, which might be needed to stimulate policymakers to divert resources and attention to natural pandemic prevention and preparedness.
On the other hand, this kind of gain-of-function research presents at least three major risks. First, it introduces a direct risk of accidental infection of lab workers, which in the worst-case scenarios could spark a new pandemic. Second, the research generates information hazards, as it attracts attention to and disseminates new techniques for generating even more dangerous pathogens that could be deliberately misused as a bad actor. Third, the publication of this kind of research in prestigious journals such as Science and Nature incentivizes other researchers to take potentially dangerous risks. It is my view that these risks outweighed the benefits, in this case.
Just a few years after the H5N1 controversy, in 2016, the Canadian scientist Ryan Noyce and his colleagues synthesized horsepox (an extinct cousin of smallpox) from scratch and published the virus’ genetic sequence. Noyce and colleagues stated they did this to vividly demonstrate the dangers posed by the possibility of scientists synthesizing smallpox in similar fashion in the future, and to stimulate discussion on the role. However, in so doing, Noyce and his colleagues may have increased the very risk that they were trying to reduce, by creating a template that could be adapted by a bad actor to synthesize smallpox more easily. Moreover, the benefit of their actions appears to have been low, as there were other ways to warn policymakers about the possibility of future artificial smallpox synthesis (Lewis 2018).
What kinds of frameworks might help make sure dual-use research is conducted safely?
I propose a few general principles that researchers should follow in order to make sure that the risks of their dual-use research don’t outweigh the benefits:
1. The research needs to demonstrate clear potential benefits.
2. The research needs to be a necessary step to achieving those benefits.
3. The research should not unnecessarily generate information hazards.
4. The research should not unnecessarily create risks of accidental lab-acquired infections.
5. The expected value of the research’s benefits should clearly outweigh the risks.
In addition, perhaps there should be absolute contraindications that are not open to interpretation, or at least require applying for exemptions from the relevant regulatory authority. For example, it might be wise to establish a rule that it is illegal to synthesize pathogens with pandemic potential absent a detailed risk-benefit review by the NSABB.
What policy levers do we have to vet dual-use research of concern?
A health system has five main policy levers for influencing system outcomes, including dual-use research of concern: financing, incentives, organization, regulation, and persuasion (Roberts et al. 2004). However, before we dive into the advantages and disadvantages of the various policy levers for ensuring dual-use research is properly vetted, it is worth reflecting on the goals of the vetting process. First, we want to detect and deter potentially dangerous dual-use research as far upstream as possible. Second, we want to minimize the compliance burden on scientists. Third, we want to involve the right people in the review process. It is likely that there may be tradeoffs between these three goals mentioned above.
With respect to the financing policy lever, major funding bodies such as the NIH, NSF, and major foundations could establish more stringent funding criteria that require careful risk-benefit justification by the grant applicants and careful risk-benefit analysis by grant reviewers. This would have the advantage of potentially halting the riskiest research early in the process. However, it could have the disadvantage of burdening legitimate dual-use research. Furthermore, it is possible that scientists dedicated to pursuing high-risk dual-use research would find alternative funding sources, or even conceal the true nature of their activities.
With respect to the incentives policy lever, major scientific journals could disincentivize dangerous dual-use research by announcing a policy to block the publication of major information hazards. One advantage of this is that peer scientists may be well-placed to evaluate potential information hazards stemming from dual-use research. A major disadvantage of this approach is that by the time research is submitted for publication, it is already done, so this would not limit the risks from accidental lab-acquired infections in the short run. Moreover, it is possible that the scientists selected for peer review would not be sufficiently trained to perform the risk-benefit analysis pertaining to information hazards. Beyond this, the effectiveness of relying on journals could be undermined by scientists shopping around for more permissive journals, if journals are unable to coordinate.
With respect to the organization and regulation policy levers, it is possible that the existing regulatory architecture governing dual-use biological research could be clarified and streamlined so that it responsibility is more clearly assigned among the various relevant government bodies. One aspect of regulation that might be helpful would be to modify the existing university Institutional Review Board (IRB) ethics review system to incorporate explicit consideration of the risks of dual-use research into their work. While it is true that many IRB committees would need additional specialized training in order to do this, it could be done.
It is clear that governments, multilateral organizations such as the WHO, and professional scientific associations all have a role to play in ensuring effective regulation of DURC. It is important to note that effective government regulation requires governments to cultivate sufficient expertise, which is often in short supply within government itself but can sometimes be hired from academia or industry. Special care should be taken by regulatory bodies to establish the volume of dual-use research of concern, and how frequently problematic research has been scrutinized and blocked in the past. International coordination between governments is of high importance in the regulatory arena, to prevent researchers from simply moving their research to countries with less stringent safety standards. Similarly, it is important that governments find ways to minimize the regulatory burden on scientists so as not to jeopardize beneficial biomedical research.
The final policy lever worth discussing is persuasion. One persuasive approach for the biosecurity community to take is to invest in efforts to train scientists on the risks associated with dual-use research. This has the advantages of being non-coercive and of not imposing additional regulatory burdens on beneficial research. However, training efforts may not be effective in influencing the scientists most naturally inclined to take risks. Moreover, training scientists about the risks associated with dual-use research has the potential to spread information hazards. Second, the biosecurity community can aggressively name and shame scientists who take risks with their research that put society as a whole at risk. This has the potential advantage of creating strong professional disincentives to undertake risky dual-use research. However, the name-and-shame approach can be abused, and it may also have its strongest influence on scientists who were already risk-averse, while the most risk-loving scientists won’t necessarily be deterred by the criticism. Even so, I suspect such efforts would be worth it.
Lingering Questions:
Reading about dual-use research of concern has raised a number of questions for which I don’t have adequate answers yet. Here are a few of them:
1) When in the research cycle do government regulatory bodies find out about dual-use research of concern?
2) How do government regulatory bodies find out about dual-use research of concern that is planned, already underway, or completed and on the way to publication?
3) What roles do different government regulatory bodies play in regulating dual-use research of concern?
4) What proportion of dual-use research of concern is known to regulatory authorities?
5) If top journals refuse to publish potentially dangerous dual-use research, will this discourage it from being conducted at all, or will the research just migrate to lower-tier journals which may provide even less oversight?
References
Bostrom, Nick, Thomas Douglas, and Anders Sandberg. 2016. “The Unilateralist’s Curse and the Case for a Principle of Conformity.” Social Epistemology 30(4): 350–71. http://dx.doi.org/10.1080/02691728.2015.1108373.
Lewis, Gregory. 2018. “Horsepox Synthesis: A Case of the Unilateralist’s Curse?” Bulletin of the atomic scientists: 1–13. https://thebulletin.org/2018/02/horsepox-synthesis-a-case-of-the-unilateralists-curse/.
Lipsitch, Marc, and Thomas V. Inglesby. 2014. “Moratorium on Research Intended to Create Novel Potential Pandemic Pathogens.” mBio 5(6).
Manheim, David, and Gregory Lewis. 2022. “High-Risk Human-Caused Pathogen Exposure Events from 1975-2016 [ Version 2 ; Peer Review : 1 Approved , 1 Approved with Reservations ].” : 1–19.
Roberts, Marc;, William; Hsiao, Peter; Berman, and Michael Reich. 2004. “Introduction.” In Getting Health Reform Right,.
Rozo, Michelle, and Gigi Kwik Gronvall. 2015. “The Reemergent 1977 H1N1 Strain and the Gain-of-Function Debate.” mBio 6(4): 1–6.
Tu, Michael. 2012. “Between Publishing and Perishing? H5N1 Research Unleashes Unprecedented Dual-Use Research Controversy.” Nti: 1–17. http://www.nti.org/analysis/articles/between-publishing-and-perishing-h5n1-research-unleashes-unprecedented-dual-use-research-controversy/#_edn8.
WHO. 2020. “What Is Dual-Use Research of Concern?” Word Health Organisation (WHO) (December): 1–2. https://www.who.int/news-room/questions-and-answers/item/what-is-dual-use-research-of-concern.