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TWiV 182 Letters

Joe writes:

Vince, here is the text of my post on Peter S site. I was disappointed in the quality of his article as I have much previous experience with his work and see him as the "David Baltimore of Risk Communication". If you could get him on as a guest you would enjoy the discussion. He reminds me of D3 in his ability to tell a story.

Regards, etc

Joe

Peter, while I have the greatest respect for you and have been to trainings by yourself and Vincent Covello in years past, I have to tell you that this article is very flawed both in the "facts" used and in the conclusions.

About 5 years ago I did the work to prepare my global organization for responding to a potential pandemic based on my concerns over H5N1, SARS and a few other pathogens. At that time I did the work to get as complete an understanding of the state of the science that I could achieve with my background in Chemical Engineering and Environmental Science. Within a few years the public discussion caught up with risk management trade's discussion on pandemics and we saw serious resources put into preparedness planning at the international, national and local levels. We have relatively robust systems in place and are working to improve the major deficiencies in prediction, vaccination and control.

The research and the researchers you are unhappy with have been an integral part in trying to get the answers risk managers like me need to make good decisions related to these preparation. Their emotional response to the criticism of a faceless unknown committee is very understandable to me. Their efforts to remain professional is to be praised and their lack of sophistication regarding risk communication seems to be something they are working to rectify.

I would argue that the Decide, Announce, Defend strategy you describe better describes the NSABB's approach than the scientists. And the target of their decision was not a few papers but the fundamental process of scientific communication among peers by publishing finds for peer review. Scientists value this in a way equivalent to the 1st amendment of the US constitution. To me their outrage is appropriate and reasonably targeted.

WRT the facts:

We know the 60% number is not accurate in the way you used it. It is the % of those who sought hospital care that died. The number of people infected is certainly much larger and there are good studies that indicate that this flu is currently in or near the typical flu Case Fatality range of 0.1%- 2%.

This flu strain is not exceptional in its lethality as you characterized it. Ebola, Nipah virus, HIV, Hep B, SARS, and many other pathogens are very similar to it or worse that it in virulence.

There is little mystery in how the 4 BioSafety Levels of protection are determined for a given pathogen.

1 = not a human pathogen,

2 = human pathogen that is not airborne transmissible, (e.g.,HIV, Hep B)

3 = human pathogen with life threatening disease that is airborne and for which we have treatment or vaccine (e.g., flu, yellow fever)

4 = human fatal pathogen possible airborne transmission with no known treatment

The BSL system had been incredibly successful at stopping lab acquired infections and loss of containment not withstanding unproven speculation about the source of H1N1 (note that it has an excellent reservoir in pigs where it experiences little evolutionary pressure)

These experiments are not as unusual as you suggest. The value in publishing them is in accelerating our ability to develop an effective treatment or vaccine. To build our defenses against a natural or unnatural outbreak. Their work is totally reproducible by any competent biologist with a supply of ferrets and virus (both readily available).

My view is the NSABB did not understand the history of research in this area, made a knee jerk decision to ban the details and were caught by surprise when knowledgeable people protested the impacts of their decision on all scientists.

Warmest Regards and please keep on with the business of improving our risk dialogs.

Joe G.

EH&S Manager

Peter Sandman responds:

Thanks, Joe, for your kind remarks about my work and your thoughtful ones about upcoming risk communication challenges. And thanks for sending me your critique of my Genetic Engineering & Biotechnology News piece on the H5N1 publication debate.

I’m drafting a response to the latter, which I hope to have ready to post with your comment in a few days.

For the sake of clarity: I have posted three commentaries on this issue so far. (This Guestbook comment-and-response will be #4.) Here they are in chronological order:

“Bird flu risk perception: bioterrorist attack, lab accident, natural pandemic” (http://www.psandman.com/gst2012.htm#NSABB) – a Guestbook entry posted on January 19, 2012.

“The H5N1 Debate Needs Respectful Dialogue, Not “Education” or One-Sided Advocacy” (http://www.psandman.com/col/WHO-H5N1.htm) – the article TWiV discussed, really an email to Lisa Schnirring of CIDRAP News, posted on February 17, 2012, which she drew on for her article (http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/feb1712meeting.html) of the same date.

“Talking to the Public about H5N1 Biotech Research,” (http://www.psandman.com/articles/H5N1-1.htm) – the article you read, submitted to Genetic Engineering & Biotechnology News [ital] on March 18, 2012. (The version the magazine published [make “version the magazine published” a link to http://www.genengnews.com/gen-articles/talking-about-h5n1-research/4067/] on April 15 under the same title is somewhat shorter.)

All the best.

--Peter

P.S. I’m not sure whether it makes sense for me to participate in a future TWiV netcast or not. I’d be interested if the focus were on risk communication issues raised by the controversy … not the technical issues where the moderators are experts and I’m a novice. (Even if I were right – or more likely half-right – on a technical point, they’d still outrank me and could still out-argue me.) But given that the papers are headed for publication now, a conversation about the risk communication implications of the mooted publication debate would probably seem pretty peripheral to the TWiV audience, I think. Still, I’d be open to an invitation of the three moderators think it makes sense … and I won’t feel slighted if they think the moment has passed.

Joe responds:

Peter, it is interesting to me as we continue this dialog (and now that I have read the actual paper discussed on TWIV) that it is a perfect example of how much people can disagree even when given the same facts!

I don't think the work that has created the ruckus is that different than similar work going on all over the world with a variety of organisms, many that I find much more concerning than H5N1. I must admit that I don't watch TV news so I may have missed some of the drama. My view at the time was that the researcher, Dr. Fouchier, created the problem by announcing to the media that "he had created the world's scariest virus" (assuming the facts I saw are accurate). I later heard him talk on the TWIV episode in Dublin and he seemed much more circumspect now that he has experienced some "live fire" media training. Now that I know he had to pre-mutate the wild virus to give it a starting chance to passage through the ferrets, I find the risk of a pandemic lower not higher than before. What he did actually proved just how high the natural barrier is between H5N1 and mammals.

There is a lot of research being done in BSL 3 and 4 labs that could be much more worrisome than this if it was not done with the extreme caution and rigid rules of the BSL 3 and 4 labs. Since one of my jobs is to coordinate with the safety staff that run the BSL 3 and 4 labs in the USA to allow our field service engineers to come out and repair our instruments in their labs I know just how seriously everyone takes these rules. When you say the virus is stored in a lab, that does not quite conjure up the reality of how they are stored in a double sealed container in an isolation system within at least two other isolation systems (BSL 4 labs live within a BSL 3 lab that usually are attached to a BSL 2 lab).

Has there been a lot of media coverage of angry scientists on this issue? I haven't seen it but would not expect to if it does not show up on the web. I ask because I would not characterize most researcher in the biotech world as dismissive of public concerns. These are in fact the same folks who volunteered to put on the Asilomar conference when folks were scared of genetic engineering in the 80's. I can't think of many branches of research that took what could have been considered uninformed fear more seriously.

One part of this debate that has baffled me is the focus on not publishing this kind of work when that is exactly what we need to develop realistic response plans. The irony of it is that I would bet the eternal box of doughnuts that there was much scarier work being done 10-20 years ago to weaponize smallpox that was never published because we were not supposed to be doing it. You and I did not have a need to know! They are not saying don't do the work just don't publish the results! All the (minimal) risk with none of the valuable gain.

Regards

PS. you would have fun on the TWIV podcast. Actually the discussion that would be very worthwhile would be on how to better communicate the need for vaccines to an ever more confused public. A great venue to reach the scientists and doctors interacting with people on this critical issue. The hosts spent many episodes trying to get the science clear on CFS and the purported links to the XMRV virus as it was breaking news the last 2 years.

Joe

EH&S Manager

Josh writes:

Dear TWiV Doctors,

I have a suggestion for a listener pick of the week: Dr. Paul Offit's course on Vaccines from UPenn on Coursera. It starts in June and is free. It does not appear to be an technical course, but rather a general examination of the history, science and use of vaccines. As such it might of more interest to lay-people than people in the field. My assessment might be inaccurate, however, since I have not taken it (yet).

https://www.coursera.org/course/vaccines

Sincerely,

Josh

 

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