I'm very excited to talk to you today about
what my colleagues and I have been working
on to address Global Catastrophic Biological
Risks, or GCBRs.
So, what I'll talk to you about today is the
definition that we have proposed for GCBRs,
why we think this is an important topic to
work on, and why you might be interested,
what can be done to address these risks, and
what we are doing at our center to work on
them.
And then I'll finish up by talking about what
you as members of the EA community might do
if you're interested in this topic to engage.
Before I jump into GCBRs directly, I first
want to tell you a little about how our center,
the Center for Health Security got its start,
and this is kind of a classic public health
story that you may know a little bit about,
but what I think demonstrates the devastating
power of infectious diseases, but also the
power of humankind to address these types
of risks.
Our center was co-founded under the direction
of Dr. D.A. Henderson who some of you may
know was the leader of the World Health Organization's
campaign to eradicate smallpox back in the
1970s and 80s.
Prior to 1977 when he had the last case of
smallpox in nature, the disease was endemic
to many parts of the world.
Even when smallpox had been eliminated from
some places like the United States, smallpox
was killing about 2 million people a year
before eradication began.
And even in the US, as late as 1947, when
there was an introduction of a case from somewhere
else in the world, it was a huge problem.
New York City in 1947 there was one imported
case, which resulted in just a handful of
secondary cases.
And that resulted in the vaccination of I
think about 2.5 million people in New York
City.
So that's just an illustration of what a problem
this was.
Smallpox was one of the most dreaded diseases
of history.
It killed about a third of the people who
were infected, and those who survived where
permanently scarred.
Some people, even though they survived, were
blinded by the disease as well.
It was particularly devastating when it was
introduced into an immunologically naïve
population, a population that hadn't experience
the virus before.
So for example, when smallpox along with measles
and some other childhood diseases were introduced
into the Western Hemisphere in 1492, over
the next century it resulted in an epidemic
that killed up to what's estimated as 90%
of the native populations that were impacted.
This resulted in societal collapse.
Social order and economies collapsed for these
native populations.
Fortunately smallpox also ushered in the vaccine
era with discovery of the first vaccine by
Edward Jenner, but without vaccine, and for
these naïve populations, the disease could
be catastrophic.
So smallpox was a terrible burden for humanity
for centuries, but its eradication was one
of humanity's greatest achievements I would
submit.
Dr. Henderson really took up the mantle of
eradication when he was called upon, maybe
reluctantly at first.
But the program that he helped lead was the
true testament to what can be done when you
have excellent leadership, some operational
ingenuity, and some really simple tools.
When DA started his work in Geneva, smallpox,
as I said, was endemic to many parts of the
world.
The goal of eradication of course was to have
zero cases, or "smallpox zero" as they called
it.
But practically in order to reach that goal,
they had to reach both some of the most densely
populated areas on earth, and also some of
the most remote villages that were very hard
to access.
And it had to be done on a shoestring budget.
The estimate for the total cost of eradication
was only 300 million dollars for about a 10
year program.
There were specific characteristics of the
variola virus, the smallpox virus that made
it possible to eradicate.
It only infected humans, meaning that there
was no animal reservoir, so it didn't lurk
somewhere else with the possibility of being
reintroduced into the human population.
It was not communicable until someone was
symptomatic, so there was no asymptomatic
spread, which would make it more difficult
to control.
And we had a very effective vaccine.
There was also a very simple tool that was
developed during the eradication campaign,
some of you may have heard of it, it's the
bifurcated needle, which is pictured here.
The bifurcated needle works, you dip the needle
into some of the smallpox vaccine, it holds
that very small amount of vaccine liquid in
between the prongs through capillary action.
Then that is used to vaccinate on an arm,
it's pressed into the skin multiple times.
That was actually very effective, that was
enough to induce immunity, and it was also
very easy to teach somebody how to give that
vaccination.
So what that meant for DA and his team was
that they could deputize people all over the
world to go out and become eradicators.
Tens of thousands of people in all corners
of the globe were going from house to house,
from village to village, and giving this vaccination
and helping with eradication.
The reason I start with this example is that
it both demonstrates as I said the power,
the catastrophic nature of some infectious
disease emergencies.
But it also conclusively proves, I think,
that humanity has the capacity to come together
to work, to combat these types of infectious
disease and biological threats on a global
scale.
So I take hope from this for the future, because
I think now we know that there are biological
events that are possible that could be much
worse than smallpox.
On to Global Catastrophic Biological Risks:
these are one of a few categories of risk
with the potential, I think, to either severely
and even permanently derail humanity.
Our center has been working to help define
these risks, and this is just a short summary
of what we think characterizes GCBRs.
They are events in which a biological agent
could lead to sudden extraordinary widespread
disaster.
Importantly in order for an event to be catastrophic
they would have to quickly go beyond the normal
capabilities of governments and the private
sector to manage these events.
And if totally unchecked they would have many
other devastating effects beyond just the
death toll of the disease itself.
As a shorthand for catastrophic biological
events we think of GCBRs as at the level of
1918 influenza pandemic and above.
As you may know, the 1918 flu is estimated
to have killed on the order of 50 to 100 million
people, which is more than were killed in
all the wars of the 20th century alone.
Obviously most biological events are not going
to be catastrophic.
We have such a long history of epidemics and
even pandemics, that were either brought under
control, or just didn't have the characteristics
that would make them catastrophic events.
But we do think there are a handful of scenarios
that could have this catastrophic potential.
Specifically we think it's conceivable that
bio-warfare could be catastrophic.
Globally we have a history of offensive biological
weapons programs by nation states, many of
which were discontinued in the 70's and the
80's.
In addition, the US had a biological weapons
program which was also discontinued.
But we think that there are some nations that
still have this as an active focus.
Bioterrorism, particularly a series of bioterrorism
attacks, has the potential to be catastrophic,
depending on the agent that's used.
Giving recent advancements in a synthetic
biology and biotechnology, the risk of an
accidental or an intentional release of an
engineered pathogen could be catastrophic.
There are some scenarios we think in which
an ecosystem that we rely on as a society,
as humanity for survival, if that were disrupted
through biological means, that could be catastrophic,
or potentially elimination of a major food
source.
And finally there's a possibility of a natural
emergence.
Of a novel, highly virulent, highly transmissible
pathogen, which could be a bad day for us.
So, although the probability of any one of
these things happening is very small and difficult
to quantify, all of these scenarios, if they
were to occur, I think could alter the course
of human history.
So, as the point that was made this morning,
I think spending some time and investing some
effort in combating some of these risks is
important to do.
There you go.
Now that I've spoken a little bit about the
risks, I want to highlight some of the work
that our center is doing to begin to address
these problems.
I should also say that there are a number
of other organizations like The Future of
Humanity Institute, The Cambridge Center for
Existential Risk, the Center for Catastrophic
Risk that have been addressing other types
of catastrophic risk, like you heard this
morning: AI, nuclear winter, but GCBRs are
still a relatively new area of study.
So, in beginning to think about these risks,
our center wanted to first propose a definition,
some of it which you've just seen, and examples
of potential GCB events.
My colleague, Monica Schoch-Spana is currently
working on a project looking at fine tuning
that definition and also trying to find ways
to communicate about these risks so that more
people can get engaged and involved.
My colleague Amesh Adalja, who you will hear
from next, just finished a project looking
at the characteristics of pandemic pathogens,
what would make a pathogen more likely to
become a pandemic or a GCB event.
We have work going on by Dr. Gigi Gronvall,
who did a red teaming exercise recently.
She brought together biologists from all stages
of their careers to brainstorm about how biology
could be misused.
That was done with the purpose of trying to
improve our ability to detect and understand
when something bad is going to happen in biology.
So those are the risk side of the equation.
We're also working on some projects looking
at how do you address these risks?
My colleague, Caitlin Rivers is working on
a project to bring epidemic modeling, and
data science, more into the field of epidemic
response, which doesn't always happen now.
And I'm working with a team, including Caitlyn,
Tara Sell, Matt Watson, to look at types of
technologies that we think could be useful
in either preventing or in actually responding
to a serious pandemic.
We're keeping in mind the gold standard of
the bifurcated needle.
That's what we want to do.
We want to find the next bifurcated needle.
So, one other project that we're very proud
of which we recently finished, was called
the Clade X Pandemic Exercise.
So this was something that we did just last
month.
We brought together senior leaders, former
government officials including former Senator
Tom Daschle, a former CDC Director Julie Gerberding,
a former FDA commissioner, and they all came
together and sat at the table and went through
our exercise which was a catastrophic risk
exercise.
Yeah, that one.
So we live streamed the event, which has a
lot of interesting lessons.
I was going to play for you a video, but unfortunately
it's not working.
But the Clade X exercise involved the fictitious
release of a genetically engineered pathogen
which was a pair influenza virus with added
variance factors from a closely related virus.
This combination made Clade X about as transmissible
as SARS and less than influenza.
Its case fatality ratio was also moderate,
greater than that of 1918 flu, but much less
than viruses like Ebola or H5N1 flu.
The virus in the scenario was introduced in
multiple attacks around the world, and then
it spread more globally.
The scenario progressed and eventually led
to a catastrophic outcome, with more than
150 million deaths worldwide within about
18 months.
So some of the key points that were highlighted
in this scenario were about the need for rapid
development, manufacturing and distribution
of vaccine, which we heard a little bit about
in this morning's fireside chat.
The need for planning and how we will respond
in this kind of an event, and the need for
both national and global cooperation and preparation.
These are just to name a few of the issues.
This is archived online if you're interested
in going back and watching any part of the
day.
We're excited to see that this is already
raising awareness in the US and internationally,
and we're hoping it will have some more tangible
impacts to where we've got an indication that
it may be influencing some legislation that's
moving in the US House right now, which is
exciting.
All that being said, there is a lot more work
that we need to do to reduce GCBRs.
If you're interested in this topic, and you
want to engage further, there's a number or
ways I think that members of the EA community
can engage.
The first is working and innovation.
As I said, finding the next bifurcated needle
is a big challenge, but it could change the
game for GCBRs.
If you want to do research there's a number
of graduate programs, some of which were highlighted
on our recent 80,000 Hours podcast with our
director.
And we're also starting a doctoral level program
at Johns Hopkins, focused on health security.
And we're looking for students.
Another way to contribute is to apply to an
organization to donate your time or resources
to help organizations who are tackling these
issues.
If you don't want to do research, policy change
is extremely important as well.
My brief experience - I went into government
briefly at the Federal level.
There's a lot you can do from inside government
to make changes.
And finally promotion, spreading the word
about Global Catastrophic Biological Risks
is always very important.
So I think with that, I'll end my presentation.
Thanks for your attention.
My contact information is up here and I'll
be around for the next day and a half or so.
Feel free to come talk to me.
All right, so we've got a few minutes for
questions.
And again, of course you can put those through
on the app, or on the website, and there are
quite a few that have come through just in
the last few seconds.
Okay.
First, are we just getting lucky?
I mean, this hasn't happened in a 100 years,
but I can recall Ebola, and SARS and there's
always the kind of bird flu, swine flu news
items running around.
Is this rare or are we lucky, or how should
I be thinking about that?
So I think you're going to hear more about
that from my colleague, Amesh Adalja, but
I think it's a combination of luck and sometimes
we are able to intervene in some of these
outbreaks to make them less severe.
But I do think we've seen a number of pandemics
in history that have been quite devastating
for humanity, and so I do think it's kind
of an inevitable thing that we will see something
else.
Going to audience questions, do you see danger
in bringing the brain trust together, such
as you did in this - you kind of alluded maybe
to something like - there were some lessons
learned in the livestream.
So is there a potential risk in just bringing
people together and thinking about this in
a structured way in the first place?
Yeah, so there's not a way to classify information
outside of the government space, but I think
it's really important to keep in mind that
there is information risk when you're talking
about these things.
We don't want to create a recipe for somebody
to follow, to do something really terrible.
And we definitely keep that in mind in everything
that we do.
Gigi's project has some potential information
risk, but she every step of the way wanted
to keep that in mind and make sure that information
wasn't put out into the world, that made the
risks worse.
Can you contextualize for us maybe what 150
million deaths looks like to the 6.85 billion
of us who are still hopefully around when
that happens.
Does that bring us to the brink or are we
resilient to that?
I don't have any intuition.
I think we've seen resilience to that level
of pandemic before.
There are different flavors of catastrophic
risk.
Our center has focused on all across the spectrum,
but we come from a background of doing traditional
bio-security.
We think it's really important to focus on
these higher level risks, but I think there
are some that could derail humanity, but not
necessarily end humanity.
But there may be some existential risks as
well.
So there are definitely more questions than
we will be able to get to you, but you're
gonna be available at our next break, during
our next break for office hours.
Yes.
So there's another opportunity to engage with
Crystal there.
Do you think there are lessons from other
categories of x-risk that can be applied to
Biology?
You mentioned that it's kind of a little bit
newer - they're all pretty new.
But are there things that you can draw from,
say, the AI research field to apply to your
work.
Yeah, we think GCBRs are so new that even
just taking the time to sit down and think
through in a systematic way, what these risks
are, is a good start, I'm sure there are many
other lessons that can be learned from existential
risk research, but we're basically at the
definition stage I think with GCBRs.
We have a lot of work to do.
Cool, maybe just the last question that we'll
have time for right now.
Are there any particularly compelling platforms,
systems, technologies in the space of pandemic
preparedness that you think would be just
worth highlighting for the audience as kind
of leaders to familiarize themselves with?
Yeah, so we've just done this project looking
at technologies that we think could be helpful.
There's a number of technologies that I think
are potentially game changing.
One that, although there's a lot of risk potentially
with Synthetic Biology, it is one of our best
tools to combat these issues.
So, using Synthetic Biology, doing distributed
manufacturing of medical countermeasures I
think could be something that changes the
game when we need to respond to something
bad.
There'll be a lot more information in our
report coming out so I don't want to go into
too much depth, but I think that's one area
of needed investment.
Cool, well unfortunately that is all the time
we have.
How about a round of applause for Crystal
Watson?
Thank you.
