0:00

to Public Health On Call, a podcast

0:02

from the Johns Hopkins Bloomberg School

0:04

of Public Health, where we bring

0:06

evidence, experience, and perspective to

0:08

make sense of today's leading

0:11

health challenges. If

0:16

you have questions or ideas

0:19

for us, please send an email

0:21

to publichealthquestion at jhu .edu. That's

0:24

publichealthquestion at

0:26

jhu .edu. for future

0:28

podcast episodes. Researchers

0:31

in China recently reported in a

0:33

journal that a new bat coronavirus

0:35

has the potential to spread to

0:37

humans. While the finding was

0:39

important Other scientists expressed concern

0:42

about how the research was

0:44

done. In this episode,

0:46

Johns Hopkins Virologist Dr. Andy

0:48

Peckosh returns to the podcast to

0:50

talk with Stephanie Desmon about

0:52

how biosafety standards for labs vary

0:54

around the world and what

0:56

that could mean for studying future

0:58

viruses with pandemic potential. Let's

1:01

listen. Andy Peckosh,

1:03

thanks so much for joining me. Oh,

1:06

as always, my pleasure. In

1:08

March. some researchers from

1:10

Wuhan, China published

1:12

in the journal Cell

1:14

that they had

1:16

been working with a

1:18

bat virus, so

1:20

HKU -5 coronavirus, and

1:23

they discovered that it could

1:25

spread to humans. And

1:27

so, of course, this raised concerns about, could

1:29

this be a new pandemic? But really,

1:31

when I asked you about it, you said

1:33

that's not really the question. Yeah,

1:36

the real question there was, this kind

1:38

of work goes on a lot, right?

1:40

I mean, we want to get some

1:43

sense of out of the thousands of

1:45

viruses that are out there in other

1:47

animal species, what percentage of them

1:49

are close to being able to

1:51

infect humans, right? And so

1:53

this study characterized HKU5, a couple other

1:55

viruses for their ability to infect human

1:57

cells and showed that, yeah, in fact,

2:00

these viruses were able to do a quite

2:02

good job at infecting cells. The

2:04

problem with the study was

2:06

in how they did their

2:08

experiments. Those kind

2:10

of experiments here in the US

2:12

would be what we call biosafety

2:14

level three or BSL three experiments. And

2:17

that's where we work in

2:19

a laboratory that has a special

2:21

air handling system, special

2:23

filtering systems. Investigators work with

2:25

almost a full set

2:27

of outer garments plus air

2:29

protection so that we

2:31

have a higher level of

2:33

protection against potential exposure

2:35

to these pathogens. The

2:38

experiments in Wuhan were done at

2:40

what we call biosafety level two. which

2:42

is something that people here in the

2:44

US work on with, let's say, just

2:46

regular seasonal influenza. It still

2:49

has some safety positions put in place, but

2:51

for instance, you don't need to have

2:53

a respiratory protection for it. There are a

2:55

few other things that you don't have

2:57

to do. And what

2:59

really became an issue is, is

3:01

it really a good idea

3:03

to work with a potential pandemic

3:05

virus under those reduced biosafety

3:07

level two conditions? I

3:09

guess I should say not to justify

3:11

what the researchers were doing, but

3:13

they were following the Chinese biosafety recommendations

3:16

that said in China, they could

3:18

do those kind of experiments at BSL2.

3:21

But here in the US, we would have

3:23

to do that at BSL3. And I think some

3:25

US scientists were a little bit shocked about

3:27

the fact that they were doing these experiments

3:29

under that lower level of containment. So

3:31

there aren't worldwide standards for how

3:33

to handle pathogens, I understand. Now,

3:36

you know the NIH has

3:38

a good set of standards

3:40

that it utilizes for all

3:42

NIH funded research and most

3:44

institutions use here in the

3:46

US at least use those

3:48

NIH rules irrespective of what

3:50

the funding source is for

3:52

a set of experiments, but

3:54

globally every country can decide

3:56

on its own where some

3:58

of these rules are and

4:00

there is no global organization

4:02

that can set standards that

4:04

all countries have to adhere

4:06

to. That's

4:08

worrisome. Yeah, it is worrisome.

4:11

I mean, we know that this kind of

4:13

research is important, but we always want to make

4:15

sure that we're doing it under safe conditions. And

4:18

I think when people see

4:20

that The same experiment is done

4:22

under different conditions based on the country you're

4:24

in that naturally brings some questions into people's

4:26

minds. And you know, this is kind of

4:28

research that we don't want people to really

4:30

be worried about it. We want to be

4:32

as safe as we can with this work. So

4:36

the different safety levels in labs

4:38

from BSL1, which is I imagine sort

4:40

of a low level, all the

4:42

way up to BSL4, what do they

4:44

do in a BSL4 lab? So

4:47

best example of a BSL4 lab

4:49

is people who work on Ebola

4:51

virus. Pathogens that go

4:53

into BSL4 usually have

4:55

a very high mortality rate.

4:58

They oftentimes have no cure or

5:00

no antiviral treatment. And

5:02

so therefore you want to be

5:04

extra safe in terms of any experiments

5:07

that you do. And again, BSL4

5:09

is where you've seen scientists work around

5:11

in those, what look like almost

5:13

like space suits, right? That show how

5:15

really protected they are from the

5:17

organism that they're working with. So

5:20

this is about. the researchers

5:22

getting infected potentially and then

5:24

potentially bringing those pathogens out

5:26

into the rest of the

5:28

world. Absolutely. Again,

5:30

I want to be clear, even

5:33

at BSL2, we have safety considerations

5:35

to prevent that. They just get

5:37

greater and greater as the risk

5:39

from the pathogen is perceived to

5:41

be greater and greater. you know

5:43

a good example I think is

5:45

you know with SARS -CoV -2 for

5:47

instance at the beginning of the

5:49

pandemic we had to work with

5:51

SARS -CoV -2 at those biosafety level

5:54

three conditions because it was a

5:56

new pathogen we had no antivirals

5:58

we had no vaccines and importantly

6:00

there was no pre -existing immunity

6:02

in the population to it so

6:04

essentially everybody was susceptible and we

6:06

had no interventions. Recently SARS

6:08

-CoV -2 was was brought

6:10

down to a BSL2 level.

6:14

And again, that sort of makes sense

6:16

now, because all of us in the

6:18

US, except for maybe some young children,

6:20

right, have had some exposure to that

6:22

virus through vaccines, through infection. We

6:24

have vaccines available. We have

6:26

antivirals available. For instance, I

6:29

can tell people in my laboratory, they

6:31

have to get the annual COVID vaccine to

6:33

work with COVID under BSL2. So we If

6:35

the virus itself poses much less of

6:37

a risk than it did in 2019, and

6:40

we have more interventions to protect

6:42

the people working with it against

6:44

potential exposures. Regular seasonal

6:47

influenza, I understand, can be

6:49

under a BSL2, but

6:51

avian flu is under a BSL3. Is

6:53

that right? Absolutely. And

6:55

the same thing holds there. With

6:57

seasonal flu, you know, we have vaccines,

7:00

we have antivirals, we even have testing,

7:02

right, that we can do that give

7:04

us additional layers of protection. But

7:06

when people in my laboratory work with

7:08

the H5 avian influenza virus, we

7:10

do that in BSL3 because we don't

7:12

have vaccines. We do have

7:15

some antivirals, but certainly we're not

7:17

sure how effective they are against the

7:19

H5. And we also know that

7:21

H5 historically has caused more severe disease

7:23

than seasonal flu. So again,

7:25

those factors move the virus into

7:27

the BSL3 as opposed to BSL2.

7:29

It feels like you have to

7:31

really play with trade -offs here,

7:33

right? So, you know, we want

7:35

to study these dangerous pathogens because

7:37

of the potential they have to

7:39

do so much damage. So

7:41

we need to understand them. But at the

7:43

same time, it's dangerous

7:45

potentially. So where's

7:48

the... where's the balance there? And

7:50

this is where we have a little bit

7:52

of gray area, right? This is

7:54

where discussions in terms of what the

7:56

risks are, what the potential risks

7:59

are, really become critical so that everybody

8:01

is comfortable with whatever determination is

8:03

made about the level of containment that

8:05

you have to work with a

8:07

virus. Except for me, it's

8:09

very clear that anything that causes

8:11

a high mortality rate should be in

8:13

BSL3. If you don't have a

8:15

vaccine against it, then that's another reason

8:17

to put something in BSL3 because

8:19

those are things that you really want

8:21

to be really careful with. But

8:24

in some ways, you know, there

8:26

is a trade -off here because

8:28

it costs a lot more to

8:30

do experiments in BSL3 than it

8:32

does in BSL2. As an example,

8:34

it costs about $60 in disposable

8:36

equipment for one of my people

8:38

to enter a laboratory. And

8:40

if they have to enter the laboratory

8:42

two or three times a day

8:44

to do experiments, suddenly we're paying $200

8:46

just for the protective gear on

8:48

the outside. I'm not saying

8:51

I don't want to do that. I'm

8:53

just saying it's an additional cost

8:55

that we wouldn't have to incur if

8:57

we were doing those experiments at

8:59

BSL2. It also doesn't take into account

9:01

the fact that the facility itself, with

9:04

its HVAC and electrical and water,

9:06

control is a very expensive facility

9:08

to run. We have one here

9:10

at the Bloomberg School of Public

9:13

Health. And again, just

9:15

the cost of maintaining that is

9:17

much more than it is maintaining a

9:19

regular BSL2 laboratory. Is it

9:21

too dangerous for us to be studying

9:23

these pathogens at all? I

9:25

really do feel like there's a

9:27

lot that we could learn from

9:29

some of these pathogens that would

9:32

help us gauge the risk of

9:34

animal viruses as human pathogens. Again,

9:36

a lot of the containment that's

9:38

used, a lot of this training that

9:40

individuals get, help us to minimize

9:43

that risk. We can never get it

9:45

to zero, but you know, you

9:47

can never have risk at zero

9:49

for anything one does. But I think

9:51

with these pathogens, we've really worked

9:54

hard to get that risk down to

9:56

as low as possible with the

9:58

training and with the biocontainment facilities that

10:00

we have available to us. And

10:02

the knowledge that we gain from that

10:05

is something that becomes very important for

10:07

us in terms of our pandemic preparedness

10:09

in the future. So

10:11

do you, does it

10:13

keep you up at night a little? Like

10:15

what researchers other countries are doing under what conditions?

10:19

Well, you know, having gone through the

10:21

COVID -19 pandemic, it's always a concern to

10:23

me in terms of, you know, what

10:25

are the pathogens that are out there?

10:27

An example, those viruses that the Chinese

10:29

investigators work with were essentially pulled from

10:31

a cave. That cave doesn't

10:33

have any biocontainment. It doesn't have

10:35

any restrictions in terms of who can

10:38

walk into that cave and who

10:40

can walk out of that cave. And

10:42

so to me, what it does say

10:44

is that, you know, those types of

10:47

areas are a greater concern to the

10:49

general public. And those represent those risks

10:51

that we have to think about ways

10:53

to mitigate as opposed to the work

10:55

that's going on in the laboratory. That's

10:58

so interesting. So what do you

11:00

do? Well, this becomes

11:02

a real important question, right? The

11:04

investigators going into caves to

11:06

sample viruses are all dressed up

11:08

in their containment gear. Some

11:10

of the times you can see these

11:13

pictures, even in Africa these days, they're

11:15

walking out of these things in their

11:17

high containment gear, and they're walking right

11:19

past locals who are walking by in

11:21

shorts and a t -shirt, heading in

11:23

the same direction as they just came

11:25

from. So it's something that

11:27

we have to just be really

11:29

careful of. In some ways, this

11:31

is a perfect example of that

11:33

one health approach to safety, which

11:35

is, you know, we have to

11:37

think about things as the entire

11:39

sort of global community that we

11:42

interact with, taking account of factors,

11:44

including animals, our food, and

11:46

the way we handle our day

11:48

in, day out lives, because all of

11:50

those things can help contribute to

11:52

us minimizing risk of these new viruses

11:54

entering the population. And

11:57

we're sitting here in a time

11:59

when we are seeing a lot of

12:01

cuts to research in the U .S.,

12:03

in U .S. foreign aid, et cetera.

12:06

How does that change this equation or does

12:08

it? Oh, it changes it tremendously. The

12:11

best place to fight the next

12:13

pandemic is on the ground in the

12:15

places where we think the risk

12:17

is highest. You know, right

12:19

now we're doing that here in the U .S. with

12:21

dairy cow avian flu. But globally,

12:23

We have to have boots on

12:26

the ground. We have to

12:28

have capabilities locally to be able

12:30

to fight and detect those

12:32

new infections early. Because

12:34

we know that when we

12:36

act early, we can contain

12:38

things. When things spread too

12:40

far, then it becomes a real problem

12:42

for us in terms of using our

12:44

normal interventions to limit an outbreak. So

12:47

anything that happens that can limit

12:49

our ability to be local. to

12:51

be able to respond quickly is

12:53

going to make us less safe

12:55

as a global community. Might

12:58

we see people maybe skimping on

13:00

protective equipment? I mean are we

13:02

in a time when cuts are

13:04

going to be deep and or

13:06

maybe we won't not skimp on

13:08

equipment it just might not be

13:10

able to staff BSL3 labs. Yeah,

13:13

I think it's more that ladder

13:15

point Stephanie you know I can speak

13:17

from personal experience right we are

13:19

cutting back our BSL three work because

13:21

we don't have the funding to

13:23

support it and you know again rather

13:26

than do things in a way

13:28

that we don't feel comfortable doing we're

13:30

just stopping those projects and we're

13:32

preemptively stopping projects that we think could

13:34

be helpful but I think that.

13:36

That's the cost of some of the

13:39

funding is we're looking at the

13:41

short term, but we're also seeing the

13:43

long -term loss in knowledge and information.

13:45

Again, we'll help inform us and

13:47

keep up the facilities that are needed

13:49

to respond to these new and

13:51

emerging outbreaks. And personally, I find

13:53

it hard to believe that we would even

13:56

be talking about this coming right off of

13:58

a pandemic like COVID. Absolutely.

14:00

And we could probably talk for

14:02

another hour about some of the politics

14:05

and other things that go into

14:07

this. But you know, the reality is

14:09

the scientific response to COVID -19 really

14:11

helped. save millions and millions of

14:13

lives globally. And, you

14:15

know, we should be strengthening that. We don't have

14:17

to spend as much as we did during

14:19

the pandemic, but we should be able to strengthen

14:21

those so that we're at a higher level

14:23

of readiness in case we have to respond to

14:26

another pandemic. And if there's one thing that's

14:28

certain, there will be another pandemic coming down

14:30

the pipeline. Andy Pekosz, thanks

14:32

so much for joining me. Thank

14:34

you. Public

14:37

Health on Call is a podcast

14:39

from the Johns Hopkins Bloomberg School

14:41

of Public Health, produced by Joshua

14:43

Sharfstein, Lindsay Smith Rogers, Stephanie

14:46

Desmond, and Grace

14:48

Fernandez -Sassiri. Audio production

14:50

by J .B. Arbeggast, Michael

14:52

Bonfills, Spencer Greer, Matthew

14:55

Martin, and Phillip Porter, with

14:57

support from Chip Hickey.

14:59

Distribution by Nick Moran. Production

15:01

coordination by Catherine Ricardo. Social

15:04

media. Run by Grace

15:06

Fernandez -Sasiri. Analytics by

15:09

Alisa Rosen. If you

15:11

have questions or ideas for us,

15:13

please send an email to

15:15

publichealthquestion at jhu .edu. That's

15:17

publichealthquestion at jhu .edu

15:19

for future podcast

15:21

episodes. Thank you

15:23

for listening.