A group of scientific and public health experts, many drawn from the world of influenza research, concluded Friday that controversial bird flu studies should be published in full -- but only after proponents mount a concerted effort to explain the importance of doing so to the public.
As well the meeting, organized by the World Health Organization, said broader discussions need to be held to determine what the appropriate biosecurity and biosafety conditions are for future studies with the enhanced viruses created through this research.
There was no estimate given for how long those two tasks might take, though the WHO official who chaired the meeting in Geneva alluded to the groundwork for publication being laid "in the next several months."
One of the authors of the contested papers said he doesn't anticipate swift publication.
"I do not think that this is going to be rushed right now. We've been holding this up for four or five months. And so rushing it now would not be a smart thing to do," said Ron Fouchier, an influenza virologist at Erasmus Medical Centre in Rotterdam. Fouchier's work is slated to appear in the journal Science.
While Fouchier was clearly relieved to have the support of his peers and most others who attended the small, closed-door meeting, he acknowledged the issue hasn't been put to bed yet.
The U.S. biosecurity group that raised concerns about the studies by Fouchier and Yoshihiro Kawaoka of the University of Wisconsin-Madison has not withdrawn its recommendation that the papers be published in redacted form, with key sections withheld.
And the U.S. government, to which the National Science Advisory Board on Biosecurity reports, has not rescinded its request to Science and Nature that they publish only abbreviated versions of the studies.
The chair of the NSABB, Paul Keim, was the lone representative from the biosecurity world invited to the Geneva meeting. An anthrax expert at Northern Arizona University in Flagstaff, Keim suggested the final answer may not rest with the group gathered in Geneva.
"This was a dominantly flu research group and they are one of the voices that needs to be heard in this debate. ... (But) this type of policy decision can't be made by the flu research community alone. The next steps are important," he said via email.
Keim said the NSABB can only reconsider or withdrawn a recommendation if asked to do so by the U.S. government -- so far it hasn't been asked to revisit the issue.
"I think that it would be ill-advised to reverse the NSABB recommendations because of one meeting of the flu research community who actually agreed with NSABB on many things," Keim said. "The final decisions need to involve them, but also a lot more societal components."
Fouchier acknowledged his team wants to publish, but not against the objections of others. "We want to publish responsibly," he said in a telephone interview. "We do not want to get into conflicts anywhere if there's no need to."
It appears Fouchier is not alone in wanting to find ways to smooth out the very rough edges of this dispute.
The WHO's Dr. Keiji Fukuda, who chaired the meeting, said the small pool of scientists involved in this type of flu research has agreed to extend a self-imposed moratorium on further work into what might make H5N1 viruses more transmissible among people. The original moratorium would have run out in late March. There was no new end date set.
Fukuda, the assistant director-general of health security and environment, summed up the meeting this way: "Basically a pause on the use of the research, a pause on the publication and a pause on conducting further work on these new viruses."
But he said there was a general agreement that the science in the papers needs to be shared. "The value of publishing it in full and the difficulties of trying to implement a redacted article were clear to everybody. I don't think there was disagreement."
Officially, though, not everyone did agree.
The meeting didn't take votes -- issues were decided based on a consensus. But Keim did not agree with the decision that redacting the studies was unworkable.
And Dr. Anthony Fauci, the head of the U.S. National Institutes of Health, told the group he supported the recommendation of the NSABB. Fauci, whose institute funded the work, was representing the U.S. government at the meeting. To have come out in favour of full publication would have put him in opposition to his government.
Fauci described the opinion in the room this way: "It was clear that the consensus of the group was that given the clear and present danger of an evolving virus in the field, out there in the real world and the need to address this clear and present danger by research that helps to understand how viruses adapt themselves and go from one species to another ... that outweighs the hypothetical risk of a bioterrorist."
Nature editor Dr. Phillip Campbell confirmed after the meeting that his journal intends to publish in full the Kawaoka study, though he did not say when.
"Discussions at the WHO meeting made it clear how ineffective redaction and restricted distribution would be for the Nature paper," he said in a statement. "It also underlined how beneficial publication of the full paper could be. So that is how we intend to proceed."
His counterpart at Science, Dr. Bruce Alberts, said his journal will junk its plan to publish an abbreviated version of Fouchier's study in late March. Alberts said Science is waiting for clarifying information on what the decisions taken at the WHO meeting mean.
Fukuda told a virtual news conference after the end of the two-day meeting that the group felt it was not feasible to set up a system whereby the full studies would be shared with people on a need-to-know basis.
There are huge legal hurdles surrounding the sharing of information that has been redacted for biosecurity issues, especially across international borders. Fouchier said if publication were delayed until they could be worked through those issues, the studies wouldn't see the light of day for years. "It's either publish or not publish," he said.
The controversy has been raging since last fall when it came to light that Fouchier and Kawaoka had succeeded at coaxing H5N1 viruses to mutate to the point where they spread easily among ferrets. Several earlier attempts had failed to produce a more transmissible H5N1 virus.
The fact a virus spreads easily among ferrets is not a guarantee it would do so in humans, but it is impossible to prove or disprove that. The lab-made viruses cannot be tested in people.
Studies of this type have been conducted for several years, fuelled by concern that H5N1 might cause a human pandemic. Currently infections in people appear to be rare, but of those that are spotted, the outcomes are often deadly.
Concerned that the researchers' methods could be used by those with ill intents, the NSABB requested that the U.S. government ask Science and Nature to hold back key portions of the work. The U.S. government did so.
The journals and researchers reluctantly agreed, but on the proviso that a system be set up to ensure people with legitimate need to see the full works would have access to them. The Geneva meeting concluded such a system would be unworkable.
