Converging and Emerging Threats to Health Security
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Environment Systems and Decisions https://doi.org/10.1007/s10669-017-9667-0 REVIEW Converging and emerging threats to health security C. Raina MacIntyre1,2 · Thomas Edward Engells3 · Matthew Scotch4 · David James Heslop5 · Abba B. Gumel6 · George Poste7 · Xin Chen5 · Wesley Herche8 · Kathleen Steinhöfel9 · Samsung Lim10 · Alex Broom11 © The Author(s) 2017. This article is an open access publication Abstract Advances in biological sciences have outpaced regulatory and legal frameworks for biosecurity. Simultaneously, there has been a convergence of scientifc disciplines such as synthetic biology, data science, advanced computing and many other technologies, which all have applications in health. For example, advances in cybercrime methods have created ransomware attacks on hospitals, which can cripple health systems and threaten human life. New kinds of biological weapons which fall outside of traditional Cold War era thinking can be created synthetically using genetic code. These convergent trajectories are dramatically expanding the repertoire of methods which can be used for beneft or harm. We describe a new risk land- scape for which there are few precedents, and where regulation and mitigation are a challenge. Rapidly evolving patterns of technology convergence and proliferation of dual-use risks expose inadequate societal preparedness. We outline examples in the areas of biological weapons, antimicrobial resistance, laboratory security and cybersecurity in health care. New chal- lenges in health security such as precision harm in medicine can no longer be addressed within the isolated vertical silo of health, but require cross-disciplinary solutions from other felds. Nor can they cannot be managed efectively by individual countries. We outline the case for new cross-disciplinary approaches in risk analysis to an altered risk landscape. Keywords Biosecurity · Cybersecurity · Terrorism · Disasters · Health intelligence Advances in biological sciences have occurred at a faster many other technologies have applications in health and rate than changes in regulatory and legal frameworks for medicine. Equally important, these convergent trajectories biosecurity. An equally profound change is the convergence are dramatically expanding the repertoire of dual-use tech- of concepts and methods from scientifc disciplines that nologies—those which can be harnessed for beneft or harm were previously distinct and siloed. Innovations in genom- to humanity. Collectively, these trends are shaping a new ics, synthetic biology, big data, computing science and landscape for systematic risk analysis, for which there are * Xin Chen 6 School of Mathematical and Statistical Sciences, Arizona [email protected] State University, Tempe, AZ 85287, USA 7 Complex Adaptive Systems Initiative, Arizona State 1 School of Public Health and Community Medicine, UNSW University, Scottsdale, AZ 85257, USA Medicine, University of New South Wales, Sydney, NSW 2052, Australia 8 Ofce of Knowledge Enterprise Development, Arizona State University, Tempe, AZ 85287, USA 2 College of Public Service and Community Solutions and College of Health Solutions, Arizona State University, 9 Informatics Department, Natural and Mathematical Sciences, Tempe, AZ 85287, USA King’s College London, London WC2R 2LS, UK 3 University of Texas Medical Branch at Galveston, Galveston, 10 School of Civil and Environmental Engineering, Faculty TX 77555, USA of Engineering, University of New South Wales, Sydney, NSW 2052, Australia 4 Department of Biomedical Informatics, College of Health Solutions, Arizona State University, Phoenix, AZ 85004, 11 School of Social Sciences, Faculty of Arts and Social USA Sciences, University of New South Wales, Sydney, NSW 2052, Australia 5 School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Room 214, Level 2 Samuels Building, Sydney, NSW 2052, Australia Vol.:(0123456789)1 3 Environment Systems and Decisions few precedents or analytical tools. These technologies are poxvirus, closely related to smallpox, for $100,000 in a increasingly available to hostile states and non-state terror- laboratory using mail-ordered genetic sequences (Koblentz ist groups. The rapidly evolving landscape of dual-use risks 2017), illustrating the very real risk of synthetic smallpox illustrates how societal preparedness for new challenges in emerging as the cause of a pandemic. health security can no longer be addressed within isolated In addition to synthetic biology, viruses and bacteria can vertical siloes. Nor can they cannot be managed efectively be engineered for enhanced pathogenicity. A revolutionary by individual countries. Well-recognised threats in the areas new precision tool for gene editing, clustered regularly inter- of biological weapons, surveillance for bioterrorism, labora- spaced short palindromic repeats (CRISPR Cas9) associated tory security and antimicrobial resistance are discussed. We nuclease Cas9, raises concerns about dual-use potential (Ran also highlight emerging new areas of threat in the intersec- et al. 2013). Whilst CRISPR Cas9 ofers the prospect of tion of health security and cybersecurity and enabling of pre- cures to major diseases, it also enables the precision design cision harm through big data in medicine. Against this back- and construction of engineered microorganisms as poten- drop, we outline below the need for new governance and risk tial weapons of mass destruction. In 2016, the US Director analysis approaches that are global and cross-disciplinary. of National Intelligence rated CRISPR Cas9 as a leading weapon of mass destruction threat (MIT Technology Review 2016). Yet global planning for bioterrorism preparedness 1 New biological weapons of mass is still largely framed by cold war concepts and is largely destruction limited to scenarios involving agents such as smallpox and anthrax in a twentieth-century context. However, contempo- It has been possible since 2002 to create synthetic viruses rary biology presents an expanded threat spectrum with an in a laboratory, when researchers at the State University of unlimited array of possible engineered agents that transcend New York at Stony Brook published the synthesis of the the scope of traditional concepts of biosecurity surveillance, poliovirus in Science (Cello et al. 2002). There are now over preparedness and counter-measures. The convergence of 140 private companies in synthetic biology (Global Engage security threats is illustrated by the use enabling technolo- 2017), which are self-regulated with voluntary codes of con- gies such as the dark web for trade in biological weapons and duct (Samuel et al. 2009). Whilst prior biosecurity eforts planning of bioterrorist attacks (MacIntyre 2015). focused on the biological materials themselves and the inher- ent challenges of securing and accounting for these materials within laboratories, genetic code can now be transmitted 2 Challenges in detecting bioterrorism rapidly and used to create new or modifed infectious patho- gens (Kelle 2009). In the specifc case of synthetic infec- A natural epidemic is one which arises in nature, without tious agents, the unique characteristic of transmissibility intervention by humans. Unnatural epidemics are those from person-to-person raises special concerns about health which are caused by human intervention and may be delib- security. A virus manufactured in one location may spread erate or accidental release of either naturally occurring or worldwide and has a major population impact, thus requir- altered pathogens. Bioterrorism is the deliberate release ing a global risk mitigation approach. The global regulation of such pathogens to cause harm (Venkatesh and Memish of synthetic biology pertaining to communicable diseases 2003). Bioterrorism difers from other forms of terrorism in is challenging, with many models proposed (Trump et al. that a bioweapon is microscopic and invisible, and release of 2017). The TAPIC (Transparency, Accountability, Partici- a bioweapon is not always recognisable as a deliberate attack pation, Integrity and policy Capacity) framework provides (MacIntyre and Engells 2016). All category A bioterrorism a guide to good governance (Trump 2017), but there is no agents except smallpox also occur in nature. For example, enforceable global governance system in place as yet. The anthrax occurs more frequently in nature (such as through many private synthetic biology companies worldwide remain humans handling infected animal carcasses) than as a bioter- self-regulated, with voluntary guidelines about reporting of rorism attack (Fong and Alibek 2010). suspicious orders. A case in point is smallpox, for which Planning for bioterrorism is underpinned by the assump- the genome is fully sequenced and publicly available. In a tion that attacks will be recognised as unnatural, but no pub- 2017 report, the WHO (World Health Organization 2017d) lic health systems exist to diferentiate the aetiology of epi- concluded that destroying existing stocks of smallpox in the demics. Tools such as the Grunow and Finke (2002) criteria USA and Russia would serve no purpose because the virus are not well known in public health and have low sensitivity can be created using synthetic biology. Whilst it is theoreti- for detecting unnatural epidemics when tested against histor- cally possible for smallpox to be synthesised in a laboratory, ical events (Chen et al. 2017; MacIntyre and Engells 2016). experts have believed this to be a complex task. However, Public