The Rising Danger of Avian Influenza H5N1 and the Ethical Dilemma of Gain-of-Function Research

Avian Influenza H5N1: A Growing Threat

Since the first identification of the Highly Pathogenic Avian Influenza (HPAI) H5N1 virus in humans in 2003, approximately 600 cases have been reported globally, with a laboratory-confirmed case-fatality rate (CFR) of 60%. The recent death of a woman in southwest China, who had no contact with poultry, suggests a potentially worrying change in the virus's transmission dynamics, raising the possibility of human-to-human transmission, according to a report by the Federation of American Scientists.

Transmission Dynamics and Public Health Concerns

Health authorities in Guiyang, Guizhou province concluded that two patients, including the woman who died, had no contact with poultry before showing symptoms of the illness. As H5N1 influenza viruses continue to evolve and potentially gain the ability to be transmitted efficiently to humans, the public health community remains vigilant.

The Need for a Strategic Response

The evolution of H5N1 over two decades necessitates an urgent and strategic response from the global health community. Scientific efforts are primarily focused on understanding the genetic shifts that facilitate the virus’s leap among species, aiming to forestall a possible pandemic. This has led to the controversial practice of gain-of-function (GoF) research, wherein viruses are deliberately engineered to be more potent or transmissible.

Gain-of-Function Research: A Double-Edged Sword

The dual-use nature of this research—where scientific advances could potentially be misused to cause harm —places it under intense scrutiny. The debate is not just about managing the risks of accidental release but also about the moral implications of potentially providing a blueprint for bioterrorism. This precarious balance between advancing human knowledge and safeguarding public health was thrown into relief in 2012 when a moratorium was placed on H5N1 GoF studies following experiments that showed increased transmissibility in ferrets, an established model for human influenza transmission.

Mitigating Future Public Health Risks

Biosafety risks include laboratory-acquired infections or accidental release of the virus, which are major threats for public health. In fact, last year, researchers around the world took the remarkable step of imposing a moratorium on “gain-of-function” experiments due to concerns about public health risks. The following provides answers to basic questions about the risks of this type of research, the status of the moratorium, and what steps are being taken to mitigate future public health risks.

Historical Precedents and Modern Dilemmas

This isn't the first time scientists have policed themselves over security concerns. In 1974, scientists self-imposed a moratorium on recombinant DNA (rDNA) technology due to emerging bioethical concerns, resonates with today’s GoF debates. Like their predecessors, modern scientists are deeply entwined in discussions about the bounds and oversight of high-stakes research.

Next Steps for the United States

Although the H5N1 international research moratorium was lifted in January 2013, the United States has yet to resume research involving gain-of-function experiments on the H5N1 virus and is currently designing a framework for the Department of Health and Human Services (HHS) to make judgments about funding for this type of research.

Conclusion

With China’s February report of two new human cases of H5N1, the debate of moving forward with “gain-of-function” research remains of utmost importance for global public health. In light of the new cases, researchers are insistent to resume experimentation on the deadly virus in hopes to produce results for prevention or new countermeasures. But the dangerousness of the virus underscores the importance of prioritizing safety when carrying out this research, even if it means pausing for a moment to make sure experimentation does not inadvertently create more problems than it solves. What are your thoughts on this ongoing debate? Do you think the benefits of gain-of-function research outweigh the potential risks? Share this article with your friends and sign up for the Daily Briefing, which is every day at 6pm.