Diary Prequel Package — page 274

and only in 30% of the chicken viruses. This suggests that the viruses that accumulate the mutations in question are the ones that transmit from chickens to humans. In addition, many of the viruses circulating in chickens are only 2 to 3 mutations away from the mutations described by Fouchier in their modified viruses. People will argue that knowing mutations cannot help predict or alert public health officials to what will emerge as a pandemic. They state that since viruses have several routes to get to where they want to go, i.e. to be able to be transmitted, the studies in question should not even have been performed. However, historically, after pandemic viruses emerge and infect people and then you go back and trace what was evolving in birds, or (more importantly) in mammals you see a pattern where you could have actually traced and connected the dots pointing to the emergence of a pandemic. This was clearly the case where the pandemic 2009 H1N1 virus was evolving in pigs for at least 10 years and was "working its way" towards human transmissibility. If there had been better surveillance in both pigs and humans as to what was evolving, then as Tom Frieden has said, we could have had a major head-start on the 2009 H1N1 virus. What the Fouchier and Kawaoka viruses tell us is that the virus in the wild is creeping towards a virus that they have shown is capable of transmission in mammals, presumably including humans. Whether the virus ultimately uses that precise pathway or those precise mutations is not clear, but clearly these studies are critical to understand the process of evolution and adaptability of viruses that are a real threat of working their way to transmissibility in humans. Not making these data freely available to scientists only slows down the necessary work and the incentive to get more scientists involved, and does not really provide a serious terrorist with any additional advantage since these techniques have been widely available for years. An uninformed terrorist would not be able to do this. An informed virologist-terrorist just needs to go to PubMed to easily figure out what was done and how it was done. Not publishing the work may do more harm than good by discouraging legitimate scientists from getting involved. Clearly, there needs to be assurance of biosafety and biosecurity in the laboratories that work with transmissibility of H5N1. The laboratories in question (Fouchier and Kawaoka) have met or exceeded our standards for these types of studies. Redacted versus Unredacted: The impracticality of redacted versus unredacted manuscripts was clear to everyone at the Geneva meeting and the likelihood of the unredacted manuscripts ultimately reaching the internet were important factors in the consensus at WHO to publish in full after a pause to assure biosafety and biosecurity and to have a better articulation of the benefits of the research as described above. The way forward. People are making incendiary statements without really having discussed with the investigators the precise details of the experiments as described above. The interaction of the NSABB with the investigators (Fouchier and Kawaoka) was on a relatively brief conference call. Much additional information that was available during the intensive 2 day discussion in Geneva was not available to the NSABB. My recommendation is to reassemble the working group of the NSABB for a face-to-face meeting with the investigators, security