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The Independent Advisory Group on Public Health Implications of Synthetic Biology Technology Related to Smallpox

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The Independent Advisory Group on Public Health Implications of Synthetic Biology Technology Related to Smallpox A report to the Director-General of WHO The Independent Advisory Group on Public Health Implications of Synthetic Biology Technology Related to Smallpox Geneva, Switzerland 29-30 June 2015 WHO/HSE/PED/2015.1 © World Health Organization 2015. All rights reserved. All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Independent Advisory Group on Public Health Implications of Synthetic Biology Technology Related to Smallpox 2 Contents Executive summary ....................................................................................................... 5 Purpose .........................................................................................................................................................5 Background ...................................................................................................................................................5 Methodology ..................................................................................................................................................5 Implications ....................................................................................................................................................5 1. Background ............................................................................................................. 7 1.1 Objectives and process of the consultation ...........................................................................................7 1.2 Overview of smallpox .............................................................................................................................7 1.3 Report of the Scientific Working Group .................................................................................................8 2. Independent Advisory Group discussions ........................................................... 9 2.1 Methodology of scenario-based discussions .........................................................................................9 2.2 Discussion of the scenarios ...................................................................................................................9 2.2.1 Scenario 1: A remote area in a developing country ........................................................................... 9 2.2.2 Scenario 2: A densely populated city ............................................................................................... 10 2.2.3 Scenario 3: A laboratory accident .................................................................................................... 10 2.2.4 Scenario 4: Individuals inject themselves with synthesized variola virus ........................................ 11 3. Implications ........................................................................................................... 12 3.1 Risk of smallpox .................................................................................................................................. 12 3.2 Implications for preparedness ............................................................................................................. 12 3.3 Implications for research ..................................................................................................................... 13 4. Way forward ........................................................................................................... 14 Annexes........................................................................................................................ 15 Annex 1. List of participants ....................................................................................................................... 15 Annex 2. Agenda ........................................................................................................................................ 16 Annex 3. Report of the Scientific Working Group Meeting on Synthetic Biology and Variola Virus and Smallpox .............................................................................................................................. 17 Independent Advisory Group on Public Health Implications of Synthetic Biology Technology Related to Smallpox 3 Independent Advisory Group on Public Health Implications of Synthetic Biology Technology Related to Smallpox 4 Executive summary Purpose The purpose of the meeting was to provide guidance to the WHO Director-General on the public health implications of synthetic biology technology as it relates to public health measures for smallpox preparedness and control. The public health implications are for countries and for WHO, and include diagnostics, vaccines and medicines and research related to the variola virus. Background At the Sixty-seventh World Health Assembly in May 2014, WHO was requested to undertake a consultation on the use and potential impact of technologies for synthetic biology on smallpox preparedness and control, in order to further inform the World Health Assembly in its discussions on the timing of the destruction of existing variola virus stocks. As part of this consultative process a group of experts, the Independent Advisory Group (IAG) on Public Health Implications of Synthetic Biology Technology Related to Smallpox, was convened at the end of June 2015 in order to provide an assessment to the Director-General. Prior to the meeting of the IAG, a Scientific Working Group (SWG) on Synthetic Biology and Variola Virus and Smallpox was convened on 1617 April 2015 to review the evidence and inform the deliberations of the IAG. The SWG addressed relevant scientific and technical questions around the re-creation of variola virus; the risks and benefits of synthetic biology for variola virus research; and the guidance required from WHO regarding distribution and handling of live variola virus maintained at the two designated WHO collaborating centres that are authorized repositories of variola virus. The conclusions of the SWG were as follows: “With the rapid advances in synthetic biology, there is now the capability to recreate the variola virus, the causative agent of smallpox. While recreating variola is quite complex, it is increasingly possible due to the availability of genetic material and of machines for complex assembly, as well as increasing know-how among a broad array of persons. Furthermore, the rapid rise in availability of genetic material from commercial sources and the so-called “grey market” is driving the cost of this material down, making recreation possible by multiple institutions and persons, including those with malicious intent. The “WHO Recommendations concerning the distribution, handling and synthesis of variola virus DNA” should be revised. Consideration should be given to adding a component or separate document on guidance to commercial DNA providers for screening requests for DNA fragments. With the development of these technologies, public health agencies have to be aware that henceforth there will always be the potential to recreate variola virus, and therefore the risk of smallpox re-emerging can never be fully eradicated.” Methodology A scenario approach was chosen to foster discussion and debate on the implications of synthetic biology among the members of the IAG. They were expected neither to comment on the likelihood of occurrence of the scenarios nor to provide solutions or recommendations for them; rather the aim was to have illustrative events to frame and guide the discussions. The four scenarios described the following situations and were followed by discussions on the question of the impact of synthetic biology on controlling the emergence of smallpox disease. Scenario 1: the emergence of smallpox-like disease in a remote area in a developing country. Scenario 2: the emergence of smallpox-like disease in a densely populated city. Scenario 3: the emergence of smallpox-like disease following a laboratory
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