Data, disruption and unnatural pandemics

What business insights can we gain from the way public health experts are dealing with the confluence of big data and biosecurity?

We live in a world where synthetic viruses can be created using biological substances and equipment purchased on the dark web. Where the genetic sequence for smallpox, a disease eradicated in 1977 and now scoring highly on the risk scale for Category A bioterrorism agents, is known and can be re-created. And where our immunity to this disease is much lower than it was four decades ago, few doctors have seen a case of smallpox and our public health agencies have no experience managing its control[1].

This may sound like a work of science fiction, but it’s a very real global threat. And for Professor Raina McIntyre, Head of the School of Public Health and Community Medicine at UNSW, it’s not a question of if but when. The coming pandemic could be smallpox, anthrax, SARS or perhaps a new strain with the potential for significant social and economic impact.’

“Infectious diseases don’t recognise geographic borders,” she explains. “An experiment conducted in one country can lead to a pandemic around the world — so in terms of biosecurity we need global solutions.”

We’ve made quantum leaps in science, with gene-editing tools and DNA sequencing allowing new ways to treat and prevent disease. But Raina believes it would be naive to think scientific methods would only be used for good when those same tools can be used for harm.

“It’s been possible to create brand new viruses in a lab since 2002, and there are over 50 private synthetic biology companies around the world with these capabilities. They have a code of conduct, but it’s not mandatory. If someone ordered a suspicious sequence from them, they’d have to report it, for example, but people may not order a whole virus – just a sequence of genes.”

This threat has been with us for some time. During the Cold War, the Soviet bioweapons program was conducting research into making viruses more infectious. Today, technological advances make these tools far more accessible – and our global governance and law enforcement protocols haven’t kept pace. The double-edged sword of data “As we’ve learned from the threat of cybersecurity, there’s a tension between the benefits of data and technology, versus the risks,” says Raina. “It’s the same when it comes to the scientific methods that are being used now to genetically engineer viruses. We may be able to better treat and prevent disease, but we haven’t quantified whether that risk is worth taking.”

She says the push towards ‘open access science,’ where anyone can read scientific journals without requiring a credentialed subscription, effectively creates recipe books for engineering viruses. Meanwhile, the dark web offers a hidden marketplace for weapons, drugs and biological substances.

And as our health records are increasingly digitised, the risk of data security increases. “Medical professionals see the electronic health record and the digitisation of health as a Holy Grail. While data linkage can assist hugely in medical research it can also be a threat.”

For example, in the US large health insurance companies like Anthem Health have been hacked, and sensitive personal health data stolen. “Shortly after that incident, the Office of Personnel Management in the US had millions of employee records hacked. If this has been the work of the same perpetrator, having those two linked databases in enemy hands would be very concerning,” comments Raina. However, despite all these technological advances, epidemic intelligence gathering still has some way to go.

“We still rely on old public health surveillance processes, using validated data from laboratories, doctors or other trusted disease-reporting sources. These are reliable, but they may not be timely because data has to be checked and by the time you get the reports you’ve already delayed the response. Because epidemics grow exponentially, early detection makes control much easier.”

She gives the example of the Ebola epidemic in 2014. “If we’d picked it up when there were only a handful of cases, how many lives could have been saved?

Social media and open access information for epidemic intelligence could provide one opportunity to detect early signals more effectively. Telecommunications and technology companies are also moving into this space, providing platforms for data gathering. For example, Telstra recently won the contract for Australia’s National Cancer Screening Register[2], having invested in specialised health technologies.

A call to arms for global governance

More worryingly, there isn’t any global legislation or governance structure to address the level of biosecurity challenge we’re facing today. “We’re still operating on old paradigms from the Cold War,” says Raina.

“The Biological Weapons Convention, for example, is being revised for the eighth time this November and it’s unenforceable because it’s underpinned by old beliefs that the perpetrators of biowarfare will be nation states. It’s obvious now that there are other players, so getting countries to sign a convention will never address the problem.”

She says the US is further ahead in developing solutions, including a National Science Advisory Board to look at potentially dangerous scientific research, but a threat without borders clearly needs a coordinated global response.

“We need more cross-sectoral collaboration between health, defence, law enforcement, emergency services and other first responders at grassroots levels. In disasters, including pandemics, our systems are tested and weaknesses are exposed. One of the biggest problems is that the many sectors involved don’t work effectively together.”

These sectors may have conflicts of interest, they may duplicate expertise or resources, and they may be working under different governance systems.

“We need organisational cultural change across all these areas,” she says.

More proactive protocols for public health

In a paper published in Military Medicine in 2015[3], Raina called for a new model for responding to pandemics and outbreaks. “Public health systems tend to assume natural causes, as happened with the Rajneesh salmonella outbreak in 1984. If they incorporate aberrant pattern analysis as a flag for potential bioterrorism, this can trigger action from law enforcement, security or defence sectors to gather evidence.” In addition, proactive automated data gathering from public infectious disease websites and social media could improve outbreak detection and analysis.

This distinction between natural and unnatural pandemics is not clearly understood. “All Category A bioterrorism agents, except smallpox, also occur naturally. So the first question we need to ask is if the outbreak is natural (like the H1N1 swine flu in 2009) or unnatural (like the Rajneesh salmonella outbreak). Historically, few unnatural outbreaks have been identified as such at the time.”

Pandemic preparation for government and business

Public health organisations also need to work closely with government and businesses to develop continuity plans to mitigate the impact of biosecurity risk.

“As we’ve learned from past pandemics, while they do cause illness and death and that’s our main concern, they also have reasonably short but very sharp economic impacts on economies and societies. With SARS, for example, travel-related industries came to almost a complete standstill, and many businesses went bankrupt as a result, especially small and medium-sized businesses.”

Pandemics create a sudden surge in infrastructure and personnel requirements, making them very disruptive for government and business. “Businesses need to include pandemic planning as part of their business continuity plans. This may include working from home arrangements to avoid infection transmission in the office, prioritising essential and non-essential services, and plans for workplace vaccination and healthcare.

You also need to be prepared for a sudden reduction in staffing, because that’s what’ll happen. In a big pandemic you might have a quarter of your workforce out sick.”

In an increasingly globalised, interconnected world, travel is the major reason for the spread of infection. “Look at the Ebola case in Dallas, the big MERS outbreak in South Korea, SARS in Toronto.

All were spread by travel, and all were examples where the receiving country was completely unprepared, resulting in massive disruption and deaths,” says Raina.

Government pandemic preparation plans need to focus on the heath system and the general community. And, like businesses, governments need to have a strategy in place for dealing with a proportion of their staff being too ill to work.

It’s clear our quantum medical and scientific advances now need to be matched by quantum changes in our systems and structures for dealing with biosecurity threats at a global level. This requires the coordinated efforts of governments, health systems, law enforcement and defence agencies, and a new agenda for fighting terrorism on yet another front.

[1]Smallpox, permafrost, lab accidents and biowarfare — how high is the threat? Raina McIntyre, August 30 216
[2]Telstra wins contract for new National Cancer Screening Register, May 26 2016, ABC News
[3]Biopreparedness in the Age of Genetically Engineered Pathogens and Open Access Science: An Urgent Need for a Paradigm Shift, C Raina MacIntyre, Military Medicine Vol. 180 September 2015