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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

‘Fraid new world: Pressing the mute button will not stop the mutation

Calling research to make highly virulent H5N1 avian influenza A transmissable between humans “a potent, real-world example” of cutting- edge science that poses as much danger as benefit, a national committee recently affirmed its censorship of the research protocols. Members of the US National Science Advisory Board for Biosecurity cited the growing risk that such research could be “be deliberately misused and that the consequences could be catastrophic.” Though rare cases of human-to-human transmission have occurred since H5N1 emerged from wild bird populations in 1997, the virus has never been able to effectively spread and emerge as the next pandemic threat. That is a very good thing, because the mortality rate in human cases – the vast majority of which have been infected by animals – is roughly 60%. “Recently, several scientific research teams have achieved some success in modifying influenza A/H5N1 viruses such that they are now transmitted efficiently between mammals, in one instance with maintenance of high pathogenicity,” the committee concluded. “This information is very important because, before these experiments were done, it was uncertain whether avian influenza A/H5N1 could ever acquire the capacity for mammal-to-mammal transmission. Now that this information is known, society can take steps globally to prepare for when nature might generate such a virus spontaneously. At the same time, these scientific results also represent a grave concern for global biosecurity, biosafety and public health. Could this knowledge, in the hands of malevolent individuals, organizations or governments, allow construction of a genetically altered influenza virus capable of causing a pandemic with mortality exceeding that of the 'Spanish flu' epidemic of 1918?” In that regard, it seems like concerns would have been raised with similar fervor when government scientists re-engineered the fabled 1918 virus several years ago. Though certainly some warned it was a profoundly bad idea, there was nevertheless added another “demon in the freezer” alongside smallpox. Now we have a suppressed recipe for transmissible H5N1, which like the aforementioned viruses would swim into a global population with about as much existing immunity as a newborn deprived of mother’s milk. Of course, forewarned is forearmed, and there is no reason to think a vaccine could not be created to prevent such novel bugs. Indeed, improved capacity to rapidly develop and distribute effective flu vaccines is probably the best response the nation can have to such threats. We can hardly count on blocking communication of scientific findings as much of an answer to this problem for very long.