by Dr. Christian Enemark, Dr. James Gillespie, Dr. Jenny-Ann Toribio and
Mr. Jonathan Herington
(click here to view the speakers' profile)
Date: 14th January 2009
Venue: RSIS Seminar Room 2 and 3, Level B4
Time: 02.30pm – 05.00pm
by Dr. Jenny-Ann Toribio, Senior Lecturer in Epidemiology at the Faculty of Veterinary Science University of Sydney
In recent years, the world has witnessed a rising incidence of animal to human transmitted diseases. In her presentation, Dr. Toribio zoomed in specifically on Avian Influenza (AI) and its prevalence in the Southeast Asian region, particularly in Indonesia. The Food and Agricultural Organisation (FAO) has classified AI in Indonesia as being endemic, given the wide spread of the disease and the high mortality rate. In light of this, she gave a comprehensive overview of the factors contributing to the spread of AI and the measures needed to curtail its spread.
1. What is Avian Influenza?
In providing a brief overview of the disease, she noted that the Influenza A virus has various subtypes and is mostly found in birds – particularly wild aquatic birds. Avian influenza has spread worldwide, while bird-to-human transmission has only occurred in a handful of countries. In the Asian region, AI was first discovered in China in 1996. The virus has since spread: first to Hong Kong, followed by Southern China and finally Southeast Asia. It is also highly pathogenic, which refers to its high mortality rate in poultry infections. The virus is also highly resistant to avian host immune systems, making it difficult for experts to develop vaccines to the strains, which have limited effectiveness because of the speed at which influenza evolves. In light of this, the best way to address AI would be to contain the virus at its source. To do so would require a careful examination of the sources and spread of the virus.
2. Factors contributing to the spread of AI
There are several factors that affect the emergence and spread of AI. These are the increase in poultry production without improved biosecurity measures, free range duck production and live bird markets – which may allow greater likelihood of infected birds mixing with healthy birds – and the close contact between poultry and people during the raising and slaughter of poultry.
It is therefore important to examine the varying degrees of biosecurity measures taken by different sectors of the poultry industry to examine the means of preventing the spread of viruses. The first sector consists of industrial farms. These farms are fully integrated, have high levels of biosecurity, have complete control over inputs and outputs and implement H5N1 vaccination. However, government veterinarians have little access to this sector. The second sector consists of breeding farms which are equipped with a high to moderate level of biosecurity, and similar to the first sector, there is little access to government veterinarians. The third and fourth sector, however require the most attention and consists of small commercial farms and village chickens breeding in backyards. These sectors have very low levels of biosecurity as there is a lot of direct human to bird contact. Moreover, hygiene standards in these sectors are often poor and exacerbate the spread of infectious diseases. The situation is complicated by the fact that chickens in live bird markets are collected from various sources and mixed together, making it difficult to precisely trace the source of a virus.
3. Preventive Measures and Challenges
As espoused by the World Health Organization (WHO) and the FAO, the best way of preventing the spread of the virus would be to contain it at its source. As such, efforts should address the third and fourth sectors of the poultry industry. In terms of bird-to-bird transmission, the following measures can be adopted: (1) preventing contact between poultry (particularly chickens and ducks); (2) preventing exposure of people and equipment to infected birds; (3) preventing exposure of people and equipment to contaminated water and; (4) stopping the unsafe disposal and sale of sick birds and dead birds.
For bird-to-human transmission, the following measures can be adopted – (1) cease the slaughter and consumption of sick and dead birds; (2) avoid close contact with infectious, sick and dead poultry (particularly children – on-farm, in market and residential areas) and; (3) use of protective clothing and hygienic practices on-farm and in slaughter facilities.
There are, nevertheless, several challenges to implementing these measures. For instance, large countries with decentralized bureaucracies may not be able to monitor the movement of poulty, thus making control difficult. Efforts at controlling the spread are also hampered by the lack of technical capacity for human and animal health, imbalanced levels of commitment in the poultry industry, the lack of community awareness, public misconceptions and ignorance.
Dr Toribio ended by noting that despite these challenges there have been some instances of positive action. NGOs have promoted education on avian flu, which has enabled early detection and response. The role of Muhammadiyah in Indonesia has been pivotal given its capacity building initiatives and community surveillance and empowerment. In the third sector, there has been industry-driven change in farms such as the provision of incentives to comply with health and safety standards and the adoption of cost-effective biosecurity measures.
Multi Drug Resistant Tuberculosis and the Securitization of Illness: Australia and Papua New Guinea
by Dr. Jim Gillespie, Senior Lecturer, School of Public Health, University of Sydney, and Deputy Director, Menzies Centre for Health Policy (MCHP).
Threats that new and emerging diseases will cross national borders have opened a new set of policy responses – the securitization of illness. In his presentation, Dr Gillespie examined the threat posed by tuberculosis (TB) in the open border between the Western Province of Papua New Guinea (PNG) and the Torres Strait Islands, which resulted in a short-lived crisis with considerable attention in the Australian media. The presentation thus examined the origins of the ‘crisis’ – both in the rapid spread of TB associated with HIV/AIDS in PNG and the inability of an underfunded healthcare system to provide a coherent response. Moreover the presentation examines wider implications of the case for migration, border control and the application of theories of ‘securitization’ to new and emerging diseases
1. Tuberculosis as an emerging disease
Dr Gillespie first noted that while tuberculosis has traditionally been seen as a disease associated with poverty and malnutrition, it has become more prevalent due to its re-emergence and strong links with HIV/AIDS and the discovery of new TB strains, such as multi-drug resistant (MDR-TB) and extensively drug resistant (XDR-TB). Essentially, TB is transmitted fairly easily amongst people with weak immune systems, but it also comes about due to the failures to cure standard TB, ie. the poor application of existing treatments.
According to WHO statistics in 2006, PNG and Timor Leste account for the heaviest burden of TB in the Pacific. PNG also has a serious HIV situation, with an under-reported prevalence of 4%. The age group most affected is that between 15 to 45 yrs old. The long-term effects of this epidemic are serious, as the loss of the most economically active segment of the population could impede growth.
To address TB, the WHO introduced the DOTS (Directly Observed Treatment, Short-course) strategy in the 1980s, which has been identified by the World Bank as one of the most cost-effective health strategies available in dealing with TB. The strategy consists of 5 components: (1) political commitment (which was never clearly defined); (2) diagnosis by sputum smear microscopy (the main laboratory technique used for the diagnosis of TB in resource-poor countries); (3) guaranteed drug supply; (4) direct observation by health workers (to address the problem of antibiotic resistance when patients stop taking the drug); and (5) epidemiological monitoring.
2. Crisis unfolding in Papua New Guinea and Australia
Circumstances in Papua New Guinea (PNG), however, made it difficult to implement any such strategy to address TB. In PNG, the New Organic Law of 1995 resulted in the devolving of health services (but not funds) to local districts. The result of this was administrative paralysis due to incidents of violence and corruption. In addition to this, the political instability resulted in the closure of aid posts and an under spending of the allotted budget. PNG also suffered from an outflow of its workforce, as medical practitioners fled to Australia’s Northern Territory for stable job prospects. Given the lack of medical services in PNG, many sought medical help in the Torres Strait Islands (TSI), even though they did not legally have access to medical treatment in the TSI. Nevertheless, the porous border between PNG and the TSI has made it easy for people travel between PNG and the TSI easily.
Events in Australia, on the other hand, had seeded an air of suspicion towards migrants from PNG. This was due to the rise in populist nationalism and health security in Australia, as advocated by Pauline Hanson. Ms Hanson had blamed the rise of Asian immigration in 1996 as the primary factor for the rise in HIV prevalence in Australia. In addition to this, an audit of Queensland’s health sector concluded that additional resources were needed to interrupt the ongoing transmission of MDR-TB in the western province of PNG to the Torres Strait Islands. More attention was brought to the situation via the Australian media who noted the dearth of health care in the Torres Straits, and that if not addressed, Australia would not be able to manage an impending flood from PNG.
In light of this, the Australian government responded in several ways. First, it beefed up its border control with more stringent quarantine inspection services. However, problems remained in controlling the extensive sea borders. Therefore, other responses were needed. The Australian government also provided more financial aid and expanded the DOTS strategy. $20 million was channeled into PNG over a period of five years, and funds were also allocated to build a diagnostic lab and improve clinical management. There have also been workforce interventions. Unfortunately, problems of governance in PNG still undercut these aid strategies.
Dr Gillespie concluded that problems remain with the securitisation framework. First, conceptualising a long-term illness in crisis terms devalues ‘security’ and therefore becomes coterminous with public health. Moreover, this turns attention away from long-term structural solutions to short-term ‘danger’-led interventions. There is therefore a need to look for solutions from cultural change. This would require health- seeking behaviors and improved governance measures. In addition there is a need to combine vertical and horizontal health policy approaches and to identify and promote local success cases.
Law in The Time of Anthrax: U.S. and Australian Perspectives
by Dr Christian Enemark, Lecturer Centre for International Security at the University of Sydney, and Director, National Centre for Biosecurity
Drawing on U.S. and Australian experiences, this presentation explored some of the dilemmas which arise when governments choose to ‘securitize’ infectious disease threats using regulatory mechanisms. Laboratory research on pathogenic micro-organisms is a difficult subject for security-oriented attention because, on one hand, it vitally informs medical and public health responses to infectious disease threats of natural or deliberate origin. On the other hand, biological agents, and the knowledge of what makes them dangerous, can be diverted and used for malicious purposes. The challenge for biosecurity regulation, specifically concerning biological weapons, is to maximise security benefits while minimising interference with legitimate scientific research conducted for therapeutic ends.
1. The Problem of Biological weapons
Dr Enemark noted that the problem of biological weapons is dependent on the parties that mark the map. A US based institute, for instance, would more likely label countries that oppose US governance to be more likely to pose a biological weapons threat than others. Part of the problem also lies in marrying the capability and the intent of producing biological weapons, suggesting that any country could engage in producing biological weapons if they wanted to. There is also the dual use dilemma, where research on pathogenic microorganisms could be used to produce biological weapons or to defend against biological weapons and naturally occurring disease outbreaks. The question therefore remains as to which area would be given greater emphasis.
2. Biosecurity Regulation
The United Nations’ Biological Weapons Convention (BWC) in 1972 stipulated the prohibition of non-peaceful uses of biological agents. However, it is not clear what constitutes this. As such, countries have progressively passed acts to apply the Convention to its own national settings.
Australia enacted its National Health Security Act in 2007, which declared 22 elements as security-sensitive biological agents and required that they be stored securely. The Act also required an assessment of the safety of research personnel. The Australian Security Intelligence Organization (ASIO) was also involved in the classification of biological agents. The criteria it stipulated identified dangerous agents based on the risk that they could be used as biological weapons by terrorists. The criteria in question would (1) determine agents that were of interest to terrorist organizations, (2) the feasibility of the agent’s use by terrorists, and (3) the impact of the agent’s use (in terms of the level of transmissibility, difficulty in treatment, economic impact). Such restrictions – largely based on a limited set of government interests – would ultimately skew the results of which agents should be included in the national security act. Touching on the case of Singapore, Dr Enermark noted that Singapore only outlaws non-peaceful purposes of biological agents and also defines what is meant by non-peaceful. In contrast to Australia, the scope of regulation is more extensive in Singapore.
In the case of the US, its national regulations are worded quite differently from the BWC. The crucial difference is that the US spells out that good faith research is acceptable and that a delivery system is also acceptable. Such legislation on biological agents are mentioned in the PATRIOT Act of 2002. In term of public health security and bioterrorism, there has been an emphasis on protecting personnel engaged in scientific research. While this is commendable, it has however resulted in an overall reduction in research capabilities. For instance, American scientists who wish to collaborate with counterparts in the developing world would find it difficult to do so as the latter would need to comply with various US biosecurity standards/regulations. As a result, the US loses out on research opportunities as scientists in the developing world would choose to collaborate with other scientists, such as the Russians, who have less restrictive regulations on collaboration.
3. Security and the Scientist (Case Studies)
Dr Enemark provided instances where scientists have collided with the security culture. The first case cited was that of an American scientist, Thomas Butler who brought plague samples in the US from Tanzania via London for further research in 2002. While his intentions of researching for a vaccine were commendable, he was ultimately imprisoned for 2 years for violating multiple US security regulations by crossing several state borders. This demonstrated the dilemma of how to balance control of the movement of biological agents without leaving scientists at a disadvantage in their research for solutions to deadly infectious diseases. The second case cited was of a microbiologist, Bruce Ivins, who was renowned for his work on developing an anthrax vaccine. In 2003, he was awarded the highest civilian order. However, after the Anthrax attacks in 2007, he fell under intense scrutiny and was also charged for 5 accounts of murder. This led Irvins to take his own life in July 2008. Dr Enemark thus concluded that the threat that is often overlooked is the role an insider may play in jeopardizing the status quo.
Dr Enermark concluded by highlighting future prospects of biosecurity regulation in Australia and the US. He noted that the former will be adopting a new scheme in 2009 to regulate the possession, handling, transfer and disposal of ‘security-sensitive biological agents’. The scheme is modelled on ‘select agents’ regulations introduced in the United States after the anthrax attacks of late 2001. Nevertheless, Dr Enermark noted that while the Australian government has been imposing regulations it has not provided as much incentives as the US has for scientific research. It therefore, remains to be seen whether Australia would lose out in its capacity to conduct significant research on biological agents in its drive to limit the development of biological weapons.
Synthetic Genomics: International Governance Of An Emerging Technology
by Mr. Jonathan Herington, Project Officer (Biosecurity), Centre for International Security Studies, University of Sydney
Mr Herington noted that over the past three decades there have been rapid technological advances in the life sciences which have both contributed greatly to human well-being and created new security risks – such as synthetic genomics. Although still in its nascent stages, the synthetic genomics industry is gaining speed and the Asia-Pacific region, with its rapidly expanding biotechnology sector, is likely to be a hub for both production and consumption of synthetic genomics. Complicating this dilemma is the highly globalised trade in sequence data and the dearth of international discussion on coherent strategies for regulation. This presentation explored some of the dilemmas presented by this technology, current attempts at mitigating risks and potential options for international governance.
1. What is Synthetic Genomics?
Mr Herington noted that synthetic genomics refers to the design and production of DNA/RNA for the purpose of expressing a technical product, i.e. the creation of synthetic life. Given rapid advancements in this technique, there has been an increase in production of these organisms. This is due to the easy access to DNA sequences online, which allows scientists to create organisms cheaply and quickly “in their own backyards”. While such activities would help create solutions for agricultural, energy and environmental issues, there is a security threat if they were used maliciously.
2. Potential misuse of the technologies
Gene synthesis is mostly used in the private sector. Use of this technology is scattered worldwide: in the US, Europe, Russia, China, Malaysia, South Africa and Singapore. The high distribution of the technology is largely due to its low barriers to entry. Moreover, the cost of synthesizing genes has decreased rapidly – halving every 18 months. This allows such products to be accessed by a wider range of people. It is possible, for example, to purchase the complete genome of the Ebola virus for $9000. GenBank, which is funded by the US government, offers an online database of various viruses for public use. Such easy methods of retrieving and ordering gene synthesis therefore subvert regulations regarding accessibility of these organisms.
Nevertheless, the usefulness of these online lists depends in part on the ability of these home-based scientists to acquire these agents. This is often difficult because the agents occur sporadically in nature and finding a specific strain for research is difficult. States, therefore, still have the advantage of controlling the risk of a biological attack by controlling the physical nature and availability of these agents.
3. Measures to control the proliferation
The first measure to control availability of such agents would be self-regulation by the industry, specifically by the collaboration of two gene consortiums in the US and Europe. However, self regulation remains problematic due to technical difficulties. The process of screening results for false positives and false negatives remains difficult because although DNAs and RNAs have the same agents, they have various genetic makeup.
A second measure would be to provide institutional oversight by peers. Such efforts are reflected in the work of the US National Science Advisory Board for Biosecurity. At the user level, there are attempts to introduce a holistic approach so as to address the issue of false positive and false negatives. However, the difficulty lies in defining this holistic approach and does not fully address problems that may arise from ‘backyard biologists’ and off-hours actors.
Lastly, there is the need for greater general education and awareness of the issue. Current awareness is very low but nevertheless is seen as a critical factor by most experts in addressing the issue. Thus far, the need for greater awareness is largely driven by the Biological Weapons Convention and the scientific community.
In summing up, Mr. Herington noted that the challenge for governments in addressing these concerns is to effectively regulate the security risks posed by this research, while facilitating its potential as a driver of new and exciting technologies. While still in its infancy in the Asia Pacific, it is nonetheless an area to keep an eye on, in the years to come.
Mitigating the spread of infectious diseases
In response to a question regarding Indonesia’s high mortality rate for AI, Dr Toribio noted that this was partly due to the fact that Indonesia had stopped sharing virus strains with other countries, as it felt developed countries would take advantage of the strains and use it for themselves rather than genuinely help AI victims in Indonesia. The high mortality rate could also be due to the lack of early identification. Reports suggest that only 1 out of the 135 infected persons received proper treatment, as most fatalities were diagnosed in later stages of infection.
With regards to whether the virus was genetic, Dr Toribio noted that there was no definite evidence at present, though there has been suspicion of a genetic linkage, and such cluster patterns have also been evident in other countries. Trials and tests are also being carried out on free range systems and compared with those of non-roaming duck flocks.
In response to a question whether simulations could be run to further project the likelihood of a pandemic outbreak, Dr Toribio noted that while such work ought to be done in Indonesia, there is still a lack of capacity to do so. Fortunately, there have been some recent efforts in upgrading the information systems of livestock systems with the assistance of Australia. This has reduced time lags in mapping outbreaks. Yet, such results are also dependent on the number of samples that are given to the laboratories and the information sent by farms.
In terms of biosecurity efficacy, it was important that cost-effective solutions– such as disinfectant footbaths be used. There is hence a greater need to think outside the box and adopt measure that would work outside the poultry/health sector.
In a response to a question regarding the securitization of infectious diseases, it was noted that securitization could simply be a speech act, a means of raising an issue to high politics to expedite action. Securitizing an issue would allow governments the ability to impose emergency measures – such as quarantine and transport. However, while a speech act can be made, the difficulty lies in adopting it. This is evident given Indonesia’s decentralized political system, where public health matters are left to local governments. As such, there are problems in getting provincial governments to understand the seriousness of the problem and expedite action. It is also the case that while securitization is accepted, the actual threat is changed. For instance, instead of claiming the AI virus as being a threat, certain voices may express that it is rather the unequal provision of treatment that is the real threat. While there may be truth in this, it is suspected that such sentiments are tied to anti-colonial rhetoric.
Biological weapons as a poor man’s nuclear bomb
In response to a question on the possibility of biological weapons replacing nuclear weapons, given easy access to them, the panelists noted that while there is much more interest in the use of biological weapons, the degree of compliance at the international level is very slim. Thus, there is a need to adopt an advocacy approach at the level of civil society in preventing the use of biological weapons. It was also noted that while there may be relatively easier access to biological weapons, the technical expertise of constructing a synthetic gene is much more difficult to ascertain.
Legislation and Awareness on Biological Weapons
It was noted that the existence of a blanket law for suspect agents is not effective, as it seems to be more of a quick fix rather than a comprehensive approach to addressing the problem. In addition to this, parties that are serious about defending such laws must fully understand the background of the offence and weigh the pros and cons of such actions. In response to a question regarding the 1989 Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal, it was agreed that more awareness should be given to the issue of transport and government secrecy. Much can also be learnt from the European Union’s experience as they have been rather progressive with implementing the Basil Agreement.
It is also imperative that scientists be made aware of the need to weigh public health concerns with security risks. Such efforts have been conducted by the National Centre for Biosecurity – a collaboration between Centre for International Security Studies (CISS) and the Australian National University (ANU) – in running awareness seminars for scientists, not only in furthering their awareness on the issues but also to provide a means of formulating possible ethical considerations for future research.
Dr. Christian Enemark
Dr. Enemark is Lecturer in the Centre for International Security at the University of Sydney and a Director of the National Centre for Biosecurity, a cross-disciplinary collaboration of the Australian National University (ANU) and the University of Sydney. A PhD graduate from the ANU Strategic and Defence Studies Centre, he worked previously in the Attorney General’s Department of New South Wales and as Lecturer in Global Security at the Australian Defence Force Academy. Christian has studied biological weapons issues for more than a decade and published in a variety of international refereed journals. His latest book is Disease and Security: Natural Plagues and Biological Weapons in East Asia (Routledge, 2007).
Dr. James Gillespie
Dr. Gillespie is the sesquicentennial senior lecturer in health policy in the School of Public Health at the University of Sydney, and Deputy Director, Menzies Centre for Health Policy (MCHP). After completing his PhD at the University of Cambridge, he worked for the Australian government and in the Urban Research Unit, Australian National University and the Department of Politics and International Relations, Macquarie University.
As deputy director of the MCHP's Sydney node, He is establishing its program on governance of the hea