Creating a Mammalian-Transmissible A/H5N1 Influenza Virus: Social Contracts, Prudence, and Alternative Perspectives

Abstract

Much has been written about 2 unpublished manuscripts submitted to Science and Nature that describe research studies in which mutant derivative strains of highly-pathogenic influenza A/H5N1 virus were created that can be transmitted by respiratory droplets or aerosols between mammals (specifically, ferrets) [1–23]. These manuscripts were referred by the US government to the National Science Advisory Board for Biosecurity (NSABB) for assessment of the dual-use research implications of this work and to make recommendations regarding the responsible communication of the work. The results of the NSABB risk-benefit review process and the subsequent recommendation that neither manuscript be fully communicated in an open forum are well-known to the international life sciences community. We propose to address this critical issue from both a historical perspective, the view through the rearview mirror, and from a future perspective, the view forward through the windshield. From the rearview mirror perspective, we review critical guidance from the life sciences community that predates the formation of the NSABB but clearly provides a relevant framework for our deliberations regarding the recent A/H5N1 virus research. We also consider existing work that the NSABB had completed prior to this recent research. From the windshield perspective, we consider 3 issues involving social and ethical principles that these 2 studies and any other future research efforts must address. We do not cover issues related to the A/H5N1 case-fatality rates or the potential benefits in sharing the entire research record of these studies for purposes of improving A/H5N1infection surveillance or countermeasure production. We posit that the case-fatality rates associated with A/H5N1 virus infection are worrisome and that the potential benefits at present are limited, but we suggest that other important matters deserve treatment here [8,19]. The concept of dual-use research of