Comment on "Gain-of-Function Research and the Relevance to Clinical Practice"

Dual-Use and Infectious Disease Research

Despite rapid advance in the prevention, diagnosis, and treatment, infectious diseases remain a central challenge for global health policy. In the twenty-first century, the life sciences—including microbiology, virology, and immunology—have been marshalled as key tools in the fight against infectious disease, and the promotion of global health. Rapid advance in these fields, however, has given rise to the “dual-use dilemma,” when one and the same piece of scientific research or technology has the capacity to help or harm humanity. While not unique to fields that address infectious disease, contemporary cases of dual-use research are largely identified in the context of the life sciences. In this chapter I outline the debate about dual-use research in the life sciences, in particular the ethics of dual-use research. After a historical overview of the dual-use dilemma in the twenty-first century, I examine ethical issues in attempting to trade off the risks and benefits of dual-use research. I address how we select alternative, less risky experiments; translational issues arising for dual-use research; and political commitments to realise the benefits and mitigate the risks arising from such research. I then discuss the governance of dual-use research, before concluding with a brief discussion on priority setting in infectious disease research as a path forward for policymakers.

Why Do Exceptionally Dangerous Gain-of-Function Experiments in Influenza?

This chapter makes the case against performing exceptionally dangerous gain-of-function experiments that are designed to create potentially pandemic and novel strains of influenza, for example, by enhancing the airborne transmissibility in mammals of highly virulent avian influenza strains. This is a question of intense debate over the last 5 years, though the history of such experiments goes back at least to the synthesis of viable influenza A H1N1 (1918) based on material preserved from the 1918 pandemic. This chapter makes the case that experiments to create potential pandemic pathogens (PPPs) are nearly unique in that they present biosafety risks that extend well beyond the experimenter or laboratory performing them; an accidental release could, as the name suggests, lead to global spread of a virulent virus, a biosafety incident on a scale never before seen. In such cases, biosafety considerations should be uppermost in the consideration of alternative approaches to experimental objectives and design, rather than being settled after the fact, as is appropriately done for most research involving pathogens. The extensive recent discussion of the magnitude of risks from such experiments is briefly reviewed. The chapter argues that, while there are indisputably certain questions that can be answered only by gain-of-function experiments in highly pathogenic strains, these questions are narrow and unlikely to meaningfully advance public health goals such as vaccine production and pandemic prediction. Alternative approaches to experimental influenza virology and characterization of existing strains are in general completely safe, higher throughput, more generalizable, and less costly than creation of PPP in the laboratory and can thereby better inform public health. Indeed, virtually every finding of recent PPP experiments that has been cited for its public health value was predated by similar findings using safe methodologies. The chapter concludes that the unique scientific and public health value of PPP experiments is inadequate to justify the unique risks they entail and that researchers would be well-advised to turn their talents to other methodologies that will be safe and more rewarding scientifically.