An open letter about ethics, to the editorial board of the journal EcoHealth

This is a minimally modified letter version of a letter sent to 99 of the 105 people listed as affiliated with the editorial board of the journal EcoHealth, for whom I could locate valid email addresses. It was originally sent on November 6, 2022. I am the sole author.

Hyperlinks not in original, text marked between asterisks added, e.g **text added **. An erroneous url address has been corrected.

So far (November 16, 2023) five of these 99 people have responded in a substantial way (on topic). One mixed, one very supportive, two supportive, one a bit hostile.

I will update this summary from time to time.

28 Sept 2023. I am aware two have resigned, in part because of their discomfort over this issue. Two more have left, I don't know the reasons as yet. No one new has joined. One co-authored an essay with me, published in the Daily Mail called "There has been a suppression of the truth, secrecy and cover-ups on an Orwellian scale"

COVER LETTER:

Dear Dr,

I am writing to you (see attached letter) because of your role in the journal EcoHealth, a journal I was associated with from its inception until my resignation, as a co-editor, in 2013. This letter appeals for EcoHealth to publish an editorial (or a guest editorial) which revisits the debate over “gain of function” research, to follow its earlier one, from 2012 (for which I was a co-author, as are several recipients of this email).

That biohazards can result from recombinant DNA technology was recognized in the 1970s, and the concept that such organisms can harm human health should be no more challenging today (in the Anthropocene) than the idea that greenhouse gases or biodiversity loss could influence human health was to pioneers in those fields, including my mentor, the late Prof Tony McMichael (a co-editor, with Pim Martens and Jonathan Patz, of one of the two main precursor journals of EcoHealth).

I appeal for you to read the attached letter (2 pages) with an open mind, and, if you are sympathetic, use your influence with Ecohealth and its parent association to explore and develop these ideas.

Kindest Regards

Colin

Colin Butler PhD, MSc, BMed, DTM&H 

Honorary Professor, National Centre for Epidemiology and Population Health, Australian National University, Australia

Member of Scientific Advisory Committee: Doctors for the Environment, Australia

https://researchers.anu.edu.au/researchers/butler-cdd
http://colindbutler.weebly.com/
http://www.bodhi-australia.com/
http://health-earth.weebly.com

https://orcid.org/0000-0002-2942-5294

colin.butler@anu.edu.au 

 

***

ATTACHED LETTER:

Dear Dr

I am writing to you because of your connection with the journal EcoHealth, a journal I was associated with from its inception until my resignation, in 2013 (at which time I was a co-editor).

EcoHealth is stated as a central platform for fulfilling the mission of the EcoHealth Alliance (EHA), which is to “strive for sustainable health of people, domestic animals, wildlife, and ecosystems by promoting discovery, understanding, and transdisciplinarity” (1).

This description of EHA’s mission omits the word ethics, but I believe it is implicit, especially in the words “strive for sustainable health”. Furthermore, ethics is relevant to all scientific endeavour.

You, are, of course, aware of the ongoing catastrophe of the COVID-19 pandemic. Some of you will be aware of its potential link with “gain of function” research, defined recently in a report by WHO (2) as:

"Research that results in the acquisition of new biological phenotypes, or an enhancement of existing phenotypes. Gain-of-function research that is anticipated to enhance the transmissibility or virulence (or both) of potential pandemic pathogens raises significant biosafety and biosecurity risks, as well as dual-use concerns that may warrant additional oversight’.

Some of you will know that the Lancet Commission about SARS-Co-V-2 (3) concluded that:

“The proximal origin of SARS-CoV-2 remains unknown. There are two leading hypotheses: that the virus emerged as a zoonotic spillover from wildlife or a farm animal, possibly through a wet market, in a location that is still undetermined; or that the virus emerged from a research related incident, during the field collection of viruses or through a laboratory-associated escape.”

The key message of an even more recent report (released October 20, 2022) published by the United Nations Environment Programme (4) into the pandemic makes a similar case, stating as a “key message” that:

"The leading hypothesis to explain its origin is that the causal virus, SARS-CoV-2 (a coronavirus) has evolved naturally in an ecological milieu in which different species of farmed or smuggled animals, or both, exist in proximity. A more speculative hypothesis is that the causal virus either escaped from a laboratory after either being brought there for purposes of study or escaped after evolving in a laboratory owing to experimentation."

This report **(for which I am sole author)** concludes:

“it is possible that the crisis caused by the current pandemic will lead to a fundamental awakening to the danger of humanity’s recent trajectory, energizing reforms such as improved governance and cooperation, a new economic system, greater respect for nature and reduced corruption. To this end, greater transparency is required, particularly concerning the ethics of gain of function research.”

A letter (in press) **(for which I am sole author)** (5) comparing this UNEP report with another UNEP report (published in 2020) (6) argues that “Critics of such experimentation (i.e. gain of function of concern) argue that it has profound risks, and requires exemplary governance, transparency and oversight if it is to be safely undertaken.

This letter also proposes that laboratory created (or “laboratory-nurtured”) organisms (such as evolving by serial passage in animal models, including genetically altered animal models, such as mice with human airway cells), should be regarded as “novel entities”. As most of you know, this is one of the planetary boundaries, and thus is relevant to planetary health. By extension, such organisms are relevant to ecohealth and to One Health. This letter also points out that the foreword to the recent WHO report, written by the WHO chief scientist, already links “biorisk management” to One Health.

The risk of creating potentially pandemic pathogens was explicitly recognised in the Cambridge Declaration (2014) (7) but it is also implicit in the warning given by the Committee on Recombinant DNA Molecules, chaired by Paul Berg. In 1974 this committee stated:

“Several groups of scientists are now planning to use this technology to create recombinant DNAs from a variety of other viral, animal, and bacterial sources. Although such experiments are likely to facilitate the solution of important theoretical and practical biological problems, they would also result in the creation of novel types of infectious DNA elements whose biological proper they would also result in the creation of novel types of infectious DNA elements whose biological properties cannot be completely predicted in advance. There is serious concern that some of these artificial recombinant DNA molecules could prove biologically hazardous” (8).

These ideas are surely no more challenging today (in the Anthropocene) than the concept that greenhouse gases or biodiversity loss could influence human health was to pioneers in those fields, including my mentor, the late Prof Tony McMichael (a co-editor, with Pim Martens, and Jonathan Patz, of Global Change and Human Health, one of the two main precursor journals of EcoHealth).

I therefore appeal, **if you are sympathetic** for each of you to use your influence with Ecohealth and its parent association to explore these ideas.

I also recommend that “ethics” be more prominent on the EcoHealth website, and that you consider appointing several ethical advisors. I also recommend that EcoHealth publish an editorial (or a guest editorial) which revisits the debate over “gain of function” research, to follow its earlier one, from 2012 (for which I was a co-author, as are several recipients of this email) (9).

References

1. https://www.springer.com/journal/10393/aims-and-scope

2. WHO (2022) Global Guidance Framework for the Responsible use of the Life Sciences. Mitigating biorisks and governing dual-use research. Geneva, Switzerland: WHO https://www.who.int/publications/i/item/9789240056107

3. Sachs J.D., Karim S.S.A., Aknin L., et al. (2022) The Lancet Commission on lessons for the future from the COVID-19 pandemic. The Lancet; 400: 1224-1280. https://doi.org/10.1016/S0140-6736(22)01585-9

4. United Nations Environment Programme (UNEP) (2022) COVID-19: A Warning. Addressing Environmental Threats and the Risk of Future Pandemics in Asia and the Pacific. Bangkok, Thailand: UNEP. https://wedocs.unep.org/20.500.11822/40871

5. Butler C.D. (2022) Comparing two United Nations Environment Programme reports on COVID-19. Science in One Health: 100003. https://doi.org/10.1016/j.soh.2022.100003

6. UNEP (2020) Preventing the Next Pandemic: Zoonotic diseases and how to break the chain of transmission. Nairobi, Kenya: UNEP. https://www.unep.org/resources/report/preventing-future-zoonotic-disease-outbreaks-protecting-environment-animals-and

7. Cambridge Working Group. (2014) Consensus statement on the creation of potential pandemic pathogens (PPPs). http://www.cambridgeworkinggroup.org/documents/statement.pdf

8. Committee on Recombinant DNA Molecules, Berg P., Baltimore D., et al. (1974) Potential biohazards of recombinant DNA molecules. Proceedings of the National Academy of Science (USA); 71(7): 2593-4.  https://doi.org/10.1073/pnas.71.7.2593

9. Jeggo M., Butler C., Jing F., Weinstein P., Daszak P. (2012) EcoHealth and the influenza A/H5N1 dual use issue. EcoHealth; 9: 1-3. https://doi.org/10.1007/s10393-012-0768-4

Ebola, WHO and the timidity of some infectious diseases experts to criticise those with power

This is slightly adapted from a blogpost published in BODHI, one of the NGOs I co-founded in 1989. That is called Ebola, WHO and the failures of a market based approach to global health.

The importance of the "milieu" (the social and environmental, or "eco-social") context

In 2012 I wrote a paper called "Infectious disease emergence and global change: thinking systemically in a shrinking world" in the inaugural issue of Infectious Diseases of Poverty (impact factor now 4.1). It has been moderately successful; cited 24 times to date, and for several years it was the most viewed article in the journal (and it might still be). That paper attempted to make several controversial points. One was that the risk of a globally catastrophic influenza outbreak has been grossly exaggerated. But the most important point was that the global health community needs to pay far more attention to the "milieu", the "terrain" in which infectious diseases thrive, a point about populations analogous to that made concerning the personal milieu, the individual immune system, by the Claude Bernard, who rivalled Pasteur as the most famous French health scientist in the 19th century. I suggested that there are forms of social immunity, not just determined by "herd" immunity (conferred by vaccination) but by health literacy, poverty, health systems and environmental conditions.

In 2015 I gave an invited talk at an infectious diseases conference in Spain, which I called Poverty, demography and infectious disease. This again stressed the milieu. The opening paragraph of my abstract read:

"Generations of slash and burn neoliberal, almost laissez faire development policies, with only rhetorical nods to global conservation and equity, continue to erode not only many environmental determinants of health, but also many factors that underpin social and health development. Here are three warnings to all who will listen that we live in One World with One Health."  My three warnings concerned (a) Ebola; (b) slowed poor development even in affluent Indian children, speculatively linked to the inadequacy of the sanitation system, in turn related to discrimination against the poor, and (c) how "Planetary Overload" could produce a future milieu in which public health systems fail and old diseases (e.g. TB, plague) return.

The political correctness of leading infectious diseases experts

Unfortunately, very few people in global public health seem to be in sympathy with my main point. This perception has been strengthened by my review (forthcoming for Faculty 1000 Global Health) of a recently published report concerning the Ebola epidemic in West Africa, which is still ongoing (as of March 2016). This long article is called Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola".

Its lead author is Dr Susan Moon, from the Harvard Global Health Institute. This paper is highly critical of WHO's slow response to the appalling and frightening tragedy of Ebola in West Africa, but there seems no criticism of other big players in global health, such as the Bill and Melinda Gates Foundation, the Clinton Foundation (indeed, Chelsea Clinton is a co-author) nor, indeed, of Médecins Sans Frontières‎ (who are also represented in the authors). Worse, there is no mention of neoliberalism (or any synonym for it, such as market-based approaches) but also no criticism of vertical health programs (i.e. interventions focusing on single diseases, at the expense of  broader health systems).

The crisis of funding for WHO

In 2002, the budget of WHO was reported to be less than that spent on advertising by two cola companies (Coca Cola and PepsiCo) (1). Since then the WHO budget may have fallen even more, as evidenced by quotes (in the Lancet paper) such as: "in the wake of the global financial crisis (2008) when WHO laid off more than a tenth of its headquarters staff, outbreak response capacity was deeply and disproportionately cut." "Decades of reducing assessed contributions in real terms has starved the organisation of resources."

The Lancet article includes extensive recommendations for how WHO might be strengthened, mainly by narrowing its focus and trying to wrest a different form of funding. But, again, there is no criticism of the international milieu which determines this funding.

The paper recommends that a global strategy be developed to invest in, monitor, and sustain core national health capacities. However, the onus seems then to be largely placed on WHO to do this ("WHO should convene governments and other major stakeholders within 6 months to begin developing a clear global strategy to ensure that governments invest domestically in building core capacities and to mobilise adequate external support to supplement efforts in poorer countries.")

We cannot just focus on firefighters: we need to reduce the risk of catastrophic fires

But the broader challenge of promoting development in low-income settings appears to have been overlooked in this paper. Firefighters are needed, but so is fire prevention. London banned thatched roofs following its Great Fire (1666).

WHO cannot do everything. There is far too little recognition that market forces, untramelled, combined with laissez-faire, environmental policies and population growth generate the milieux in which Ebola and other pandemics thrive (the point I made in my 2012 paper mentioned above.) This blindspot is also evident in a paper written by Bill Gates about Ebola.

This difference can also be seen as that between Bernie Sanders and Hilary Clinton. Clinton and other supporters of neoliberalism hold most power, and appear to sincerely believe in their own rhetoric; they know best. But many younger Democrat  supporters, who strongly favour Sanders, recognise the failure of conventional policies to give hope to the poor and the young. Donald Trump's support is driven by some similar factors; especially the realisation that so-called free markets are failing the inner-cities. Trump's isolationism is likely to further erode support for WHO, and the U.N. However I am uncertain Trump's policies will be that much worse for other determinants of global health than of Hilary and Bill Gates. However, at least, Melinda Gates has some awareness of the risk of unrestrained population growth.

References

1. Lang, T., Rayner, G.; E., K. The food industry, diet, physical activity and health: A review of reported commitments and practice of 25 of the world’s largest food companies. Report to the World Health Organization; City University Centre for Food Policy, London UK: 2006.

Climate Change and Global Health: WHO meeting, August 2014

This is an adapted version of my recent post on Croakey about the WHO (World Health Organization) conference on climate change and health, held in Geneva in late August 2014.

The Australian immigration officer was unusually friendly. What kind of conference is it? “Climate change” I answered. “Good” he said. “You tell them, tell them about Maurice Newman and the others”. What he did not have to say was “tell them how these businessmen (eg David Murray, Dick Warbuton (who claims to have an open mind about climate change but is sceptical of the role of carbon dioxide!) and former politicians (eg Nick Minchin) self-taught on the issue of climate change, and with little if any scientific training and even less understanding, not only are able to expound their opinions on national media, almost unchallenged by hapless hosts, but are even able to directly influence national policy, on matters from disinvestment in “Earth poisons” (coal and other fossil fuels) to the Australian renewable energy target.

Given the proximity to the release of my edited book on this topic (September 2014) I had been hoping I might be invited. Still holding my Australian Research Council Future Fellowship, I had funds to go; the meeting being relevant to my grant (“Health and Sustainability: Australia in a global context”). Although flights were not paid by WHO the flight carbon offsets were – this was the first carbon-neutral conference in WHO history.

The weather in Geneva was lovely. The Chernobyl and atomic energy protestors (who have maintained a presence just outside the WHO precinct for decades) are still there, but more visible as roadworks have temporarily closed the normal bus-stop, so we all walked nearer to them.

Inside we were greeted by a colourful sign, drawn by children, about climate change and health. More people than originally expected had arrived – 360, including several health and environment ministers (though none, as far as I could tell, from powerful countries). Australia sent a diplomat from the Geneva office who told me she found the proceedings unusually pleasant as there was so little overt politics. That may be so but there was still plenty of politics on display, e.g. ultra-deference to some, and the barely visible line that separates what can be said from what cannot be said.

The great German philosopher Jürgen Habermas has described “critical-emancipatory” knowledge, characterised in a recent article in Nature Climate Change by Noel Castree et al as “geared to challenging the status quo and creating a world predicated on new (or existing yet currently unrealized) ideals”. In some ways, the conference reflected this; in other ways, it seems to have reinforced old habits. Many delegates called for an end to fossil fuel subsidies, for technological leapfrogging, and for a fairer world. But I was less convinced of sufficient appreciation of global inequalities, of limits to growth, and of more radical steps such as carbon disinvestment (recently endorsed by Human Rights campaigner Mary Robinson) and civil disobedience. There were also some “no go” areas, including how climate change might aggravate the risk of large-scale conflict, migration and famine. As usual, the development-hindering role of rapid population growth was off the table.

There was also a noticeable tendency, especially by the government delegates, of over-attribution. For example, climate change may well make dengue fever outbreaks harder to control, but it is not the exclusive factor.

Some big names in global public health attended, including some not well known for their work in this area, such as Professor Ilona Kickbusch.

The opening sessions were so crowded that the overflow filled two peripheral halls. Ours had a slightly party atmosphere, as, at least at the beginning, the audio-visual system let us down. Livestream watchers in the outback may have had a better connection. But I did hear some – including by WHO Director-General Margaret Chan, Prince Charles and World Bank President – and public health expert – Jim Kim (the latter two by video-link). But we missed hearing Christine Figueres, of the UNFCCC.

Later the crowd thinned, on day two we were able to sit upstairs in the main hall, and for the very final session there was space downstairs for almost all. Downstairs, one certainly felt more a part of the main event than an observer.

This was the most hierarchical and diplomatic of the handful of WHO meetings that I have attended; that is because it had an unusually large number of people, and thus an unusually large number of politicians, diplomats and civil society representatives, including of medical student groups.

Naturally, at a UN-affiliated meeting, these dignitaries come first. But there were also brief summaries of the science, discussion about the conference statement, and a focus on sub-issues such as nutrition, health promotion and strengthening health resilience.

The final day included a session on the economics of climate change, presented by Jeremy Oppenheim, program director for the New Climate Economy project.

There is a detailed summary on the web – including nine pages of the WHO Bulletin. The background paper Strengthening Health Resilience to Climate Change repeated the three tier classification of health effects in the IPCC health chapter. My book uses a somewhat similar three way structure (not credited by the IPCC), and I’m very much hoping that classification will be cited in the next version of this paper.

I wish I believed more in the carbon offset industry, I would have less carbon guilt; even so, I’m glad I attended. It might even be seen as an historic event, one day. On the whole, WHO deserves great credit for its leadership in this vital area.

Health, Environment, Population

Invited lecture to Department of Public Health and Environment, 

World Health Organization

My slides are now accessible here.

August 26, 2013

Dr Margaret Chan (W.H.O. Director General) recently criticized “Big Soda” (and other “Bigs”) as driving forces which generate non-communicable diseases. This criticism could be extended not just to Big Carbon, but big Capitalism too, and for many additional adverse health outcomes. But when it comes to the nexus between population, environment, development and health, it is not just capitalists and the Right who have a narrow vision; so too does the Left, which for at least two centuries has argued that redistribution is not only necessary but sufficient to solve poverty and resource scarcity.

This lecture will attempt to review and explain the decline of understanding and interest in Limits to Growth and population growth; the nascent but fragile revival of interest in these issues, and why these issues are central to global development, security and health: past, present and future.

***
This is a preliminary meeting which might lead to the establishment of a WHO- led working group to re-examine these issues; hopefully to re-consider the orthodox view which has dominated the Right since about 1980, the Left since at least 1800 and academia since about 1985.

For example: "The Population Association of America, representing US demographers and population specialists .. questioned the basis of the White House policy (at the 1984 Population Conference in Mexico City): ("the PAA prepared a statement commenting that the authors of the draft report was "either unaware of 50 years of demographic research, or deliberately ignored it" .. "Dr Sheldon Segal, the co-recipient of the 1984 UN population prize also questioned the US position.")

Finkle, J. L. & Crane, B. 1985. Ideology and politics at Mexico City: The United States at the 1984 International Conference on Population. Population and Development Review, 11, 1-28. (footnote 61).

***

Prof Colin Butler is funded by the Australian Research Council, as a “Future Fellow”, a four year research grant. His topic is called “Health and Sustainability: Australia in a Global Context”. He has published many articles on topics relevant to these themes, against the mainstream current, including “Overpopulation, overconsumption and economics" (Lancet, 1994) and "Human carrying capacity and human health" in PLoS Medicine (open access).

In 2009 he was named one of 100 doctors for the planet. He was lead author for the Millennium Ecosystem Assessment chapter on future human well-being in the scenarios working group, where he collaborated closely with Carlos Corvalan. He is trying to make "Limits to Growth and Health" a legitimate and central issue for global public health. He is also a contributing author to the IPCC health chapter.