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February 2007 Updates

Biosafety Bites

By Edward Hammond
The Sunshine Project
January 11, 2007


The bird flu lab accident that officially didn't happen, or how the University of Texas at Austin could have caused the next influenza pandemic, but everybody lived to cover it up


Don't ask the National Institutes of Health (NIH) about the genetically engineered influenza pandemic that might have started in Austin, Texas in April 2006. That's because until NIH reads this Biosafety Bites, they almost certainly haven't heard anything about it. And that shows yet again that the US biotechnology and laboratory safety oversight system is a dangerous failure.

NIH's Office of Biotechnology Activities (OBA) doesn't enforce biosafety rules, so the University of Texas (UT) didn't report the unsettling Bird Flu accident. UT must have reasoned: Why draw attention to a lab accident when there's no cost for burying such incidents? It surely wouldn't be the first time such an event has been swept under the rug.

BSL-3 in the Heart of Texas

According UT records obtained by the Sunshine Project, the accident happened on a Wednesday afternoon, 12 April 2006. A postdoc was working in the Molecular Biology Building ("MBB") on the University of Texas campus in Austin, just a couple minutes' walk away from tightly packed dormitories, the kind of place where a virulent new influenza strain might eagerly take hold. A little over a kilometer south is the Texas Capitol and a warren of state office buildings teeming with public employees.

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Centrifuge Accident Aerosolizes Genetically Engineered Influenza

The postdoc was working alone in a beefed-up BSL-3 laboratory wearing a full lab suit. A respirator system provided oxygen through an air hose. The high-tech safety measures were in place because the viruses in the lab were not your average flu. They were something much more dangerous. They were genetically engineered influenza strains that mixed and matched genes of the common human H3N2 influenza and those of deadly H5N1 "Bird Flu". The kind of unpredictable reassorted flu strain that public health officials fear could cause the next human pandemic.

In the BSL-3 lab, a quantity of the engineered influenza was ready for work. It had been grown mixed with cells. The experiments required purified virus. So, a little after 2:00PM, the researcher transferred a quantity of the virus mixture into a tube. The tube was capped and placed in a centrifuge on a lab bench. The centrifuge would separate out the virus through spinning - centrifugal force.

But the tube was of the wrong type for the centrifuge. There were two almost identical centrifuges in the lab, and their non-interchangeable parts had become mixed up.

The postdoc pushed a button and the centrifuge began to spin. Because the tube was the wrong type, its cap didn't fit correctly. It cracked. The centrifuge lost balance. Turning the machine off, the postdoc observed that the level of virus fluid in the tube had gone down and that its exterior had become wet, both indicators of a leak. This was a serious problem because as the machine spun around, the leaked virus had become aerosolized, at least within the centrifuge.

The Inevitable Human Error

The problem was then compounded by human error, an ever-present factor in lab work. Rather than waiting for the aerosolized flu to settle, the centrifuge was immediately opened. In an invisible puff of air, virus particles wafted out of the machine. Now, the virus was floating around the whole lab, stirred by air movements, then slowing settling on exposed surfaces or being sucked out the exhaust which, hopefully, had effective HEPA filtration (the UT documents are silent on this item).

It was something like a Bird Flu victim walking into the room and coughing all around, spreading virus where he went. Except this mixed up lab creation of H5N1 virus was possibly more efficient at infecting humans than natural "Bird Flu" because of its H3N2 human influenza parts.

The researcher sprayed Lysol and wiped up surfaces in the work area, exited the lab, took a shower, and put on new clothes. Within hours, the postdoc was taking Tamiflu, in the hope that it would stop the virus if the researcher had been infected. For several uncomfortable days, the University of Texas staff waited to see if the researcher developed symptoms. None are reported to have appeared.

The University of Texas at Austin had dodged a bullet. It took longer for a UT biosafety team to straighten out the lab and reopen it. Under any of a variety of plausible scenarios, the accident might resulted in disaster. For example, if the cap leaked but didn't crack, without the postdoc noticing, thereby multiplying the danger to include everyone working in the lab over a longer time.

UT's Bird Flu Hybrid and Deceptive Records

Reading UT's records, it is clear that the University was thinking in terms of public relations from practically the moment that the accident occurred. UT records unscientifically discuss (downplay) the risks and neglect to precisely describe the flu strain. For example, they state that the virus should be considered like far less dangerous H3N2 despite it being a hybrid with "some genes from H5N1". This is deceptive, because the bug that causes flu is composed of only 8 short pieces of RNA that collectively encode just 11 proteins.

Assuming "some genes from H5N1" means at least three RNA pieces or more, or the RNA to encode three proteins, UT's hybrid Bird Flu virus would be about 25% H5N1 (somewhere between 3/11ths and 3/8ths), and potentially much more if the "some genes" were larger ones. That's certainly enough H5N1 genetic material to create an unpredictable and potentially extremely dangerous (pandemic) reassortant. Tiny differences in genes can make huge differences in the bug. Nobody knows for sure how dangerous UT's flu was because, by good fortune, this story doesn't end in human infection.

UT's report also deceptively states "CDC recommends BSL2 practices for H3N2, but it was decided that BSL3 would be prudent for use with this agent," as if UT was acting with an abundance of caution. But UT was was working with a potentially pandemic combination of H5N1 and H3N2. And well before April 2006, there had been scientific discussion and government recommendations made about the need for BSL-3 or higher containment for flu viruses like UT's. Thus, contrary to the implication of its PR-wise assertions, UT was not taking any major steps above and beyond the basic measures that should have been used for such a virus.

Echoes of 2005's Flu Accident

It must have weighed heavily on the minds of University of Texas public relations officials (who were called than 2 hours after the accident) that one year before, on 12 April 2005, global headlines were dominated by the story of Meridian Biosciences Inc., which sent 3,700 samples of potentially dangerous noncontemporary H2N2 flu to labs in the US and across the world. If the UT accident became public at that time, its occurrence on the anniversary of the Meridian story might have cast an extra bright and unflattering light on the University of Texas, potentially unsettling the Molecular Biology Building's many neighbors, many of whom would be unhappy to learn that they came too close for comfort to being ground zero of a deadly flu pandemic.

Need for Federal Reporting

Although it would serve public health and accountability ends, perhaps it is presently optimistic to expect a university to quickly issue bad news about itself, especially when that bad news evokes images of it authoring a public health disaster. But it must be expected that such accidents definitely will be reported to the federal officials that oversee lab safety so that, at least, other labs can learn from the mistake and, for example, not put two identical centrifuges whose parts are NOT interchangeable in the same lab. And so that federal safety officials and funders could examine the accident and impose penalties if institutional safety deficiencies are identified.

Accident, Revised Out of Existence

But it does not appear that anybody outside UT found out about the incident until the Sunshine Project requested the accident report. UT fought to keep it under wraps. While the Texas Attorney General's office was weighing a UT petition to keep the accident details secret, somebody got cold feet. A UT official left two messages on the Sunshine Project answering machine offering to explain what happened, if the Public Information Act request was withdrawn. (We did not respond.)

The Public Information Act request revealed that UT never finalized its accident report and it did not inform NIH. Instead, it made the accident disappear.

How? On the morning after, officials interviewed the postdoc. Remarkably, they recorded that the postdoc's account of the accident had dramatically changed overnight. UT's Environmental Health and Safety Office writes "The researcher thought that the volume of the tube had changed, but was not 100% sure of the original volume." The liquid on the exterior of the tube? It "may have been from condensation". The lid? It, at least, was still broken.

The accident was miraculously converted into a figment of the postdoc's imagination. Pondering the possibility of being at the center of an embarrassing incident that might impair funding and anger UT leaders, was there pressure to change the story? The postdoc knows for certain; but in the absence of any enforced reporting requirements, there were precious few incentives to move forward with accident reporting. Or perhaps UT management insisted that nothing happened unless the Tamiflu-taking postdoc affirmed absolute certainty of details remembered while in the midst of scrambling to contain a potentially life-threatening accident?

Certainly, UT management seized upon the (reported) "not 100% sure" statement. On that basis UT decided that an accident had not occurred. The following gem of illogic (read carefully) provides the University's reasoning that the accident didn't happen: "There is the possibility that there was no leak and therefore no contamination occurred."

The following Monday (17 April), UT's Institutional Biosafety Committee (IBC) held a previously scheduled meeting. The incident was briefly discussed. In the IBC minutes, a new version of events appears, one that omits several critical details from the accident report. According to the IBC account, the postdoc's concern was said to have been that the tube (not cap) had cracked, but that thankfully, it hadn't. It was a mistaken impression by the young researcher. The tube was fine. And "the liquid on the tube"? It was "probably condensation". The broken cap isn't mentioned. Nor is the prematurely opened centrifuge. Nor is the decrease in the volume of the virus in the tube.

Condensation? According to the accident report, the "condensation" was observed not long after the tube was filled and almost immediately after it had been spinning at several hundred, perhaps several thousand, revolutions per minute. If it was condensation and not virus culture, then UT seems to have set a world laboratory record for the fastest-forming and most remarkably adhesive water condensation ever seen.

But as far as UT was concerned, the case was closed. No authorities were told. Officially, no accident took place, although despite the fact that nothing officially happened, UT curiously proceeded to decontaminate the entire lab "as if the contamination had occurred." The accident report remained labeled "draft" and was not finalized.

And there the story would have ended, before this Biosafety Bites.

 

Biodefense Blackout

News Release
The Sunshine Project
February 28, 2007

Texas BSL-4 Lab Keeps Records Secret
UTMB Resists Attorney General's Ruling, Case Moves to the Courts

[If the GE aspect isn't readily apparent, consider this. First, there are some accident reports, which very well may involve GE bugs, like the one in Austin. Second, the National Science Advisory Board on Biosecurity is basically charged with recommending federal policy on "risky" aspects of biodefense research which, in large measure, have to do with GE.- EH]

The University of Texas Medical Branch (UTMB), the largest university center of research on biological weapons agents in the US, is refusing to obey the Texas Attorney General and release documents requested by the Sunshine Project. Instead, UTMB has sued the Attorney General in a bid to block his ruling and keep the paperwork secret. The Sunshine Project has intervened in the case, and has asked a Texas judge to order UTMB to turn over the documents.

The Sunshine Project made its Texas Public Information Act request on 24 October 2006. The request was for nine separate categories of information, including: details on accidents in UTMB's biosafety level four (BSL-4) and BSL-3 labs, records related to the National Science Advisory Board on Biosecurity (NSABB), and contracts of UTMB's federally-funded regional biodefense center, among other items.

UTMB, which is located in Galveston, strenuously objected to handing over many of the papers, which total between nine and ten thousand pages. It filed a lengthy briefing seeking the Attorney General's permission to deny major elements of the Sunshine Project's request. Some of UTMB's partners, including the Southwest Foundation for Biomedical Research, a BSL-4 lab in San Antonio, Texas, also fought to keep information under wraps. The Sunshine Project submitted comments to the Attorney General explaining why it believes that the records should be public.

On 11 January 2007, the Attorney General's Office issued its ruling. It rejected most of UTMB's arguments and determined that the University must release many biodefense records that it sought to keep secret.

But instead of following the ruling and making the papers public, on January 22nd UTMB filed suit against the Attorney General. The case is in the 419th District Court in Austin (Travis County), Texas. UTMB's filing does not clarify which elements of the Attorney General's ruling it is contesting and, to date, it has made none of the requested records available.

The Sunshine Project has intervened in the case and on 16 February asked the judge to order UTMB to release the records. The Sunshine Project is represented by Joseph Larsen of Ogden, Gibson, Brooks, and Longoria of Houston, Texas. A hearing has not yet been scheduled.

Ironically, the Sunshine Project's decision to file the request was influenced by a March 2006 Science op-ed co-authored by one of UTMB's leaders, Dr. Stanley Lemon. A member of the NSABB, Lemon's editorial criticized an unspecified group of "politicians and their constituents" who are said to favor restricting the flow of information about research involving biological weapons agents. Lemon claims that "such measures won't reduce risks and may cause a false illusion of security."

The Sunshine Project, and most bioweapons experts, agree that transparency is critical for biological security. But according to Sunshine Project Director Edward Hammond, there can be a gap between rhetoric and reality: "Talk can be cheap when it comes to biodefense transparency. We've asked UTMB's leadership to put its paperwork where its mouth is." So far, UTMB is flunking the transparency test, undermining the credibility of its public commitment to openness. "UTMB has some explaining to do for its secretive actions," says Hammond.

The Sunshine Project is the largest biodefense-related Freedom of Information Act requester in the country. Hammond concludes "This case reflects what the Sunshine Project's Freedom of Information program is all about: applied transparency. Abstract endorsements of biodefense transparency in policy circles don't necessarily translate into openness in practice. Real-world transparency is what matters most."

For More Information

  • Attorney General's Open Records Ruling OR2007-00489:
    http://www.oag.state.tx.us/opinions/orl50abbott/orl2007/or200700489.htm
  • The National Science Advisory Board on Biosecurity (NSABB)
    http://www.biosecurityboard.gov
  • UTMB's Institute for Human Infections and Immunity and "Galveston National Laboratory":
    http://www.utmb.edu/ihii/
  • Ogden, Gibson, Brooks, and Longoria
    http://www.ogwbl.com/

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