The following is an excerpt from the book UNCONTROLLED SPREAD by Scott Gottlieb, MD. Copyright © 2021 by Scott Gottlieb. Published on Future with permission by Harper, an imprint of HarperCollins Publishers.
Establishing the odds that a lab might have played a role in expanding the COVID outbreak isn’t merely a curiosity, or a political intrigue. It’s a critical question of public health preparedness. How we handicap the probability that a lab could have played a role in the initial contagion informs how we approach efforts to guard against pandemics in the future, including how we design and regulate high-risk labs that handle some of the world’s most dangerous pathogens. We’ve traditionally focused those efforts on trying to reduce the risk of spillover events from zoonotic sources in nature as our primary means to shut off the potential origins of these kinds of catastrophic events. Going forward, to prevent the next pandemic, we have to focus equal attention on improving global lab safety.
Even now, China has not released the original strains of SARS-CoV-2, which are essential if we want to establish the virus’s origin with confidence. There may never be a hard factual record that definitively shows where the virus began, only conclusions drawn from inference and a clash of competing stories. There is still enough evidence to sustain the view that the first outbreak may have been set off by accidental infections stemming from poor handling of a lab specimen inside China.
Labs capable of handling the most dangerous pathogens, classified as BSL-4 labs, are being built all around the world, many in countries with a history of poor controls and oversight of research practices. There needs to be an international agency to oversee safety measures at these labs, and what kind of research they’re conducting, because of the well-documented risk that pathogens can escape from research facilities. Yet the global response to COVID may have made the needed cooperation more unlikely. The travel bans imposed on China, and later Europe, conditioned the world on what to expect when a country is host to a new contagion: now, travel restrictions are the new normal. These political conditions make it less likely nations will share early information about future outbreaks, zoonotic spillover events, novel pathogens, or lab accidents. We’ll see more erosion in public health collaboration as an outcome. Countries have even more reason now to hide the embers of the next epidemic.
That is all the more reason the US must rely on the intelligence community’s tools to help shield us from future threats. Historically, it was always viewed as difficult to draw our intelligence community into these sorts of missions, which were not regarded as equal to other threats to national security. On the public health side, there was the same hesitation about giving the intel community a bigger role in public health response.
The scientific community traditionally saw the intelligence community’s work as running against the principles of science, which favor open sharing of information for the widest possible public benefit. The CDC and the public health community were often unwilling to take in classified information and accept the restrictions that came with handling such material. And the public health community sometimes hesitated to share sensitive findings, even when the information could help the US adapt its response to a new threat. During the Ebola outbreak in West Africa in 2014, the CDC signed a bilateral agreement with the government of Liberia to exchange information, but the agency later declined to provide the data it collected to the US Department of Defense, saying its agreement with Liberia barred the CDC from sharing the information with “third parties.” The US military was already deployed in Liberia as part of a major mobilization to support the response to the Ebola outbreak, and the CDC would not share information that the Pentagon thought could help shape and steer its response.
Using the eighteen different agencies that comprise the US intelligence community could create important new capabilities for lowering the risk posed by naturally occurring pathogens with pandemic potential. Many public health leaders will fear a corrosive impact from using national security tools to carry out missions that were historically handled through scientific exchange and multilateral commitments and cooperation. They will worry that this new stance will taint international collaboration. Within the government, resistance to a larger role for our spy agencies has often come from the operating components of HHS. Among other concerns, HHS officials have said that tighter cooperation with intelligence agencies might complicate the overseas work of public health officials and make people suspicious of them when they travel. They worry that everyone in a white coat will be treated as a spy. But many foreign adversaries already assume that any American official traveling abroad could be working for US intelligence agencies. And the historical record shows that global commitments, multilateral agreements, and the work of our public health officials were not enough to keep us protected. They were not even enough to obtain the source strains of SARS-CoV-2, or early information that the virus in China was spreading from person to person, had infected healthcare workers, and was being passed through asymptomatic infections.
We need to look across all of our capabilities to make sure that such an event cannot happen again. Other nations are looking to their national security instruments to identify and reduce pandemic risks. We will need to make the same adjustments. Yet, as we go down this same path, we need to make sure we engage our national security instruments in a way that preserves our multilateral institutions and the work of scientific agencies. We need to continue to invest in capacity building in nations with whom we collaborate. We need to make sure that scientific exchange doesn’t become encumbered. Agencies like the NIH don’t want to be burdened with having to handle reams of classified information. Researchers want to know the provenance of any samples they receive and the environment in which it was collected so they can properly assess its usefulness.
The rules for engagement will have to be worked out carefully.
The flip side is that embedding public health information in our intelligence reporting could elevate the work of our scientific agencies. When it comes to threats from emerging diseases, policymakers aren’t reading academic papers. But they are reading the CIA’s World Intelligence Review and other national security estimates. If more health reporting were regularly included in these assessments and treated on par with other threats, it would keep it in front of policymakers, so they would be in a more informed position to secure the nation against emerging risks.
The parts of HHS have access to a great deal of knowledge that belongs in the national security conversation, but most of these operating units do not see it through that lens. It is not the environment they occupy. The national security agencies could help weave this reporting into a wider mosaic that would aid in identifying risks. At the same time, intelligence agencies could sharpen their collection and reporting through work with health experts who could add context to guide intelligence collection. The National Security Agency collects a huge amount of signals intelligence but may not know exactly what to search for without help from health experts, or how to read the information it gathers. If the NSA came into possession of sequence data, for instance, it might not have a clear understanding of how to extract this information from signals intelligence or how to make an initial analysis to judge its significance; but collecting these data would fit reasonably within its current mission, since most of this information is now shared digitally.
Leveraging our intelligence assets to inform us better on risks would also complement our diplomatic tools. More information could be shared with our diplomats to let them target their own efforts around the US public health mission. If intelligence estimates identified certain weaknesses in a nation’s institutions, our diplomats would be in a better position to know where to focus their efforts on capacity building. Perhaps it’s a foreign lab with poor internal controls or certain regions where surveillance is especially weak. These sorts of missions, where diplomatic initiatives are being fed by intelligence agencies, has been a hallmark of arms control efforts, nuclear nonproliferation, and nuclear inspection activities and a similar approach can help improve our biosecurity and surveillance as well.
We need to involve our national security agencies to monitor for these risks, alongside our public health agencies and our multilateral efforts to improve global surveillance.