Bogota, 26 Nov (Edward Hammond*) -- A large and rapidly growing global US military virus collection system parallels the World Health Organization's Global Influenza Surveillance Network (WHO GISN) but does not entirely share its public health purposes.
The US military system is a source of viruses for the WHO GISN; but it does not give most of its virus collections to WHO. It does keep all the lab specimens and viruses it collects for its own use.
Wider knowledge of the extent of the US military virus collection system and its ambiguous relationship to the WHO GISN system will raise important questions for the WHO Pandemic Influenza Preparedness Inter-Governmental Meeting (PIP IGM), which will convene in Geneva the second week of December.
The extent of the Pentagon's quiet but large virus collecting and its relationships with the WHO GISN will surprise many. For example, the Pentagon claims credit for having collected several important influenza viruses that were subsequently selected by WHO for use in seasonal and H5N1 pre-pandemic vaccines from 2000 through the present, including viruses from Panama, Peru, Nepal, Malaysia, and Indonesia.
Some developed countries, including the United States, have insisted that developing countries only share influenza viruses with the WHO GISN and not bilaterally with others. Yet, contradictorily, the United States has a massive military influenza virus collection program, but only provides a very small percentage of the materials that it collects to the WHO.
It is unclear if and how viruses collected by the US military in other countries would be covered by a WHO GISN material transfer agreement because they are obtained and transferred outside what is now- understood to be the WHO system.
If one WHO Member State unilaterally amasses influenza viruses without full participation in the WHO access and benefit sharing system there is strong potential for the WHO system to be undermined.
Also undefined is the legal status of a virus received by the WHO system; but not from an approved lab of its country of origin - a situation that now frequently occurs due to the activities of the US military virus collection system.
The US military system is active globally, including at least 56 countries where it is collecting influenza viruses (as of 2007). The system pulls in clinical specimens and locally isolated viruses that are shipped to the United States. It provides some of these viruses to the WHO GISN network, mainly through the US Centres for Disease Control (CDC), a WHO Collaborating Centre in Atlanta, Georgia (and part of the US health ministry), but keeps all specimens and viruses for its own purposes.
The size and capacity of the US military program is dramatically expanding and has more than doubled in recent years. In 2005, it was active in 30 countries and included three BSL-3 labs and a total sample processing capacity of 9,000 specimens per year. By 2007, the network was active in 65 countries and included eight BSL-3 labs and the capacity to process 18,000 samples annually.
The network is named the US Department of Defense Global Emerging Infections Surveillance & Response System ("DoD-GEIS"). A DoD-GEIS program called the US Department of Defense Worldwide Influenza Surveillance Program focuses specifically on flu viruses.
The military network has "sentinel" sites around the globe, reported by US military sources to include 128 or more locations. These are installations where US military personnel are based, as well as collaborating non-military sites that collect samples from US personnel and local civilian populations.
In 2006-2007, the system collected influenza viruses from developing countries including:
-- Americas: Belize, Guatemala, Honduras, El Salvador, Nicaragua, Venezuela, Colombia, Ecuador, Peru, Bolivia, Paraguay, and Argentina.
-- Africa: Morocco, Libya, Egypt, Eritrea, Djibouti, Sudan, Uganda, Kenya, Burundi, Gambia, Ghana, Nigeria, and Cameroon.
-- Middle East: Turkey, Jordan, Iraq, and Oman.
-- Central/South Asia: Azerbaijan, Kazakhstan, Uzbekistan, Mongolia, Afghanistan, Pakistan, India, Nepal, and Bangladesh.
-- Southeast Asia/Oceania: Myanmar, Thailand, Vietnam, Laos, Cambodia, Philippines, Indonesia, Papua New Guinea, and Solomon Islands.
A US Air Force lab at Brooks City Base in San Antonio, Texas coordinates the system. In 2006 and 2007, its systemwide budget was over $40 million per year. In the 2006-2007 flu year, the Texas lab alone processed 5,810 specimens from persons across the globe suspected to have respiratory infections. Of these, 2,444 tested positive for a respiratory virus, including 1121 positive for influenza virus. According to the US Department of Defense (DOD), "All original specimens are archived and kept for requests from [Department of Defense] partners or the CDC."
Another lab at a US Navy facility in San Diego, California processes an unknown number of additional samples. Of note, the Navy lab systematically isolates flu viruses from military personnel who become infected during port visits. Using this unusual collection method, in 2007, it isolated seasonal influenza viruses from countries including Indonesia, Papua New Guinea, and the Solomon Islands after US Navy ships docked there and US sailors became infected while ashore.
Including the Navy lab and other facilities (see below), the military system handled an overall total of approximately 8,000 influenza and other viral cultures in 2007. Of these, only a small percentage are given to CDC. In 2006, this number was 120 viral isolates (about 1.5%), meaning that over 98% of the viruses collected by the US military program do not enter the WHO system.
In addition to the CDC, collected viruses (especially H5N1 viruses) are provided to US Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick in Frederick, Maryland. USAMRIID is the historical home of the US offensive biological weapons program (terminated in 1969), and is presently the headquarters of the US military's biological defense effort. Drawing on viruses collected by the US military and WHO sources, as of 2007, USAMRIID maintained a collection of thirty different H5N1 strains plus many other flu types that it uses in research and provides to other US military labs.
According to the program, the primary purpose of the virus collection system is to ensure US military readiness: "The principal objective is to enable the rapid discovery of novel strain mutations that could trigger a pandemic and to monitor these strains for their ability to transmit and to causedisease... the priority of the DoD is to maintain readiness and protect the health of service-members and beneficiaries, the contributions from the [San Antonio-based] surveillance program also benefit the greater global health community."
Five overseas laboratories operated by the US Department of Defense act as regional coordination centres for the collection effort. The five labs are:
-- Naval Medical Research Unit No. 2 (NAMRU-2) in Jakarta, Indonesia.
-- Naval Medical Research Unit No. 3 (NAMRU-3) in Cairo, Egypt.
-- Naval Medical Research Centre Detachment (NMRCD) in Lima, Peru.
-- Armed Forces Research Institute of Medical Sciences (AFRIMS) in Bangkok,Thailand.
-- United States Army Medical Research Unit-Kenya (USAMRU-K) in Nairobi, Kenya.
With the exception of NAMRU-2, which was recently closed by the Indonesian government, each of the above labs works not only in the country in which it is located; but also in nearby countries, where laboratory and personnel detachments are sometimes placed.
NMRCD operates a high containment (BSL-3) lab in Peru, and coordinates virus collections in several South and Central American countries and, for example, has staff in Guatemala. In 2007, it reported that it is seeking to expand virus surveillance efforts in Ecuador, Bolivia, Paraguay, and Uruguay.
AFRIMS in Bangkok operates a BSL-3 lab and, in addition to work in Thailand, maintains a facility in Nepal and collects samples from other countries in the region. In total in 2007, AFRIMS collected over 1,000 respiratory samples from seven countries in Southeast and South Asia.
NAMRU-3 in Cairo has at least BSL-3 capability and collects human and animal influenza viruses. It is a WHO GISN H5 reference lab, submitting viruses both to other US government labs as well as WHO labs. NAMRU-3 maintains activities in many African, Middle Eastern, and Asian countries, from Ghana eastward all the way to Pakistan.
It states that in 2007, "From Egypt, 141 human specimens were received for influenza A/H5N1 reference testing, and 26 specimens tested positive for H5N1. H5 reference testing was performed on 459 animal specimens, with 92 positive for H5N1 from Afghanistan, Egypt, and Ghana." From these H5N1 isolates, MANRU-3 deposited HA gene sequence information for 74 strains in GenBank.
USAMRU-K in Nairobi collects virus samples from hospitals and Kenyan military facilities and says that it is developing collection capabilities through universities in Uganda and Cameroon and the Nigerian defense ministry. Flu viruses it collects are provided to the CDC and the US military.
Until the Indonesian government closed it, NAMRU-2 in Jakarta played a similar role, including coordinating US laboratory detachments in Indonesia, Cambodia and Laos. In 2007, it says that it collected and tested more than 4,500 respiratory samples in Indonesia alone. It is unclear what will happen to NAMRU-2's activities outside of Indonesia now that the Jakarta laboratory has been closed.
Other US military BSL-3 labs in the network are located in Germany and South Korea. The DoD-GEIS network also collaborates with the US Defense Threat Reduction Agency (DTRA), although the exact nature of the collaboration has not been publicly described.
Despite the Pentagon's claims that it has frequently contributed to WHO vaccine strain selections, none of the negotiating texts or background documents made available by WHO in the course of the Pandemic Influenza Preparedness Inter-Governmental Meeting have discussed the large US viruscollection system that parallels the GISN, much less explained the relationships between the two.
Nevertheless, the purpose of the US military system does not wholly coincide with WHO's public health ends, and its activities at times do not appear to be compatible with most proposals for a revised WHO GISN virus and benefit sharing system.
The massive US military virus collection system, which parallels the WHO system yet does not currently operate under the same rules, creates an additional complication for diplomats seeking an agreement on virus and benefit sharing. Its extent and different purposes than the WHO system may also be of concern to some countries, particularly because WHO system virus sharing is for public health and not military purposes.
Efforts should be made to ensure that all virus collection and transfers take place within the WHO system, using a WHO material transfer agreement, and that virus collections for purposes other than public health not be permitted.
(* Edward Hammond is an independent researcher and an expert on patents and biological resources. He contributed this article to SUNS.)
