A natural pandemic has been terrible. A synthetic one would be even worse

In 1988, as Russian scientist Nikolai Ustinov worked in the VECTOR lab, part of a Russian program to develop viral weapons, he accidentally infected himself with the Marburg virus, a deadly pathogen related to Ebola. He died weeks later. During his autopsy, a pathologist accidentally stuck himself with a needle and died as well.

At its peak, the VECTOR lab was thought to be able to produce two tons of Variola virus (the microbe that causes smallpox) per year. The lab was eventually transitioned into a research institute after the Cold War and recently helped develop the Russian Covid-19 vaccine, Sputnik V. It currently holds one of the world’s two official repositories of smallpox.

While recent debates over the origins of SARS-CoV-2 have raised more questions than provided answers, an inescapable reality we need to be considering is that the United States is woefully unprepared for a synthetic pandemic — one purposefully created and deployed to cause mass human harm.

The Covid-19 pandemic has revealed the fragility of the U.S.’s public health preparedness infrastructure when faced with a moderately deadly and moderately transmissible respiratory pathogen. We cannot begin to imagine the devastation — possibly even a threat to civilization — if the country had to face a synthetic pandemic from a virus that had been intentionally engineered to spread as effectively as measles and had the virulence of filoviruses such as Ebola or Marburg.

The Biological Weapons Convention, signed in 1972 and effective since 1975, was the first multilateral disarmament treaty that prohibited developing, producing, and stockpiling weapons of mass destruction, and specifically biological weapons. To date, 182 countries have signed on and ratified this convention. Yet the Biological Weapons Convention has been violated multiple times since its inception: by the Soviet Union through its Biopreparat laboratories (of which VECTOR was one), which developed weaponized anthrax, Ebola, Marburg, plague, smallpox and others; by Iraq, which produced anthrax, botulinum toxin, and aflatoxin during the Gulf War; and by rogue groups such as the Japanese cult Aum Shinrikyo, which attempted to isolate Ebola virus for terrorist activities during a 1992 outbreak in the Democratic Republic of the Congo.

In the U.S., pandemic preparedness efforts are currently housed across a number of institutions, including the Centers for Disease Control and Prevention, the Department of Defense, the Department of Human Health and Services (specifically the Biomedical Advanced Research and Development Authority), the U.S. Department of Agriculture, and the Federal Bureau of Investigation.

This fragmentation is problematic, as identified in 2015 by the Blue Ribbon Study Panel on Biodefense (now the Bipartisan Commission on Biodefense), a group of former high-ranking government officials who analyze U.S. biodefense capabilities. In its seminal report, “A National Blueprint for Biodefense,” the committee said that the “root cause of this continuing vulnerability is the lack of strong centralized leadership at the highest level of government.” The group laid out 33 specific recommendations to address the large gaps in the U.S.’s biodefense infrastructure.

In a follow-up report in March 2021, “Biodefense in Crisis,“ the group rightfully criticized the federal government for failing to follow-through on the majority of the recommendations, aside from the creation of a National Biodefense Strategy in 2018 which was never actually implemented. The group concluded that the U.S. “remains at catastrophic biological risk” from a synthetic pandemic.

Even in the midst of a natural pandemic, the threat of a synthetic pandemic should be at the forefront of the U.S. national security agenda. Here are four steps we believe the country’s leaders need to take.

First, leaders need to recognize that a pandemic driven by a highly virulent synthetic pathogen would be a global threat. The global community must recognize and address this. The single most important step the U.S. government can take to reduce the magnitude of the next pandemic is to provide the essential support and material resources to countries with ongoing Covid-19 epidemic surges, especially with regard to accessing vaccines (including raw materials and technology transfers), and also toward building and strengthening primary health care systems. By creating health infrastructure and new pipelines for access to essential biological materials, the U.S. can help other countries stay prepared if and when they are dealing with any novel disease outbreak.

Only by showing leadership in protecting communities globally can the U.S. engender sufficient trust to secure global support for improving surveillance and response to future threats. U.S. public health leaders must ensure that wherever the next pandemic-prone disease originates, all countries are ready to stop it quickly.

Second, federal leaders must act upon the recommendations laid out in the 2021 “Biodefense in Crisis” report. These include developing a more organized leadership structure within the federal government to coordinate biodefense activities across various sectors and creating a national biodefense hospital system that can be ready for activation in the case of a serious biological attack.

Funding must also be increased for the development of biodetection technologies and medical countermeasures, such as a larger repository of antiviral and antibacterial compounds that can be quickly distributed within cities and hospitals if needed. And the U.S. government must support the Global Health Security Agenda in efforts to strengthen international biosurveillance. Key ways to improve our biosecurity apparatus were laid out six years ago in “A National Blueprint for Biodefense.” The country failed to act on them before Covid-19 and can’t risk doing so again.

Third, the federal government must ensure that states’ hospitals and clinics are adequately equipped to avoid becoming amplifiers of emerging outbreaks. In 2005, a Marburg virus outbreak in Angola was spread primarily through the hospital where patients were being treated. Sick people tend to show up to hospitals and, if it’s unclear what is being treated, inadequate infection control measures may be used.

That was true in 2014 for the first Ebola patient in the U.S., Thomas Eric Duncan, who was initially not asked about his travel history when he arrived at a Dallas hospital, and infected two nurses, one of whom ended up traveling on a domestic flight to and from Ohio. Part of this effort must include wide availability of rapid diagnostic platforms, such as high-throughput genomic sequencing, which can quickly identify organisms of concern. Additionally, we must ensure that ventilation and decontamination practices are functioning effectively.

Fourth, federal and state governments must guarantee that the general public has immediate access to basic safety prevention measures such as high-grade masks that can filter out aerosols in the case of an airborne pathogen, the transmission route that would be of highest concern. The Covid-19 pandemic has made clear that any pandemic response efforts must start with protecting individuals as quickly as possible. Just as many people have fire extinguishers and smoke detectors in their homes, so too should they have adequate personal protection against infectious disease threats.

The emergence of SARS-CoV-2, the virus that causes Covid-19, as a human pathogen may very well have been a natural spillover event. But this pandemic should be a stark reminder that the risk of biological warfare must be taken seriously, and preparations be made for an even worse-case scenario. And the time to do that is now.

Abraar Karan, an infectious disease physician and fellow at Stanford University, worked on the Massachusetts Department of Public Health’s Covid-19 response efforts. Stephen Luby is an internal medicine physician and professor of medicine in infectious diseases at Stanford University.