The following is an excerpt from the book UNCONTROLLED SPREAD by Scott Gottlieb, MD. Copyright © 2021 by Scott Gottlieb. Published on Future with permission by Harper, an imprint of HarperCollins Publishers.

Establishing the odds that a lab might have played a role in expanding the COVID outbreak isn’t merely a curiosity, or a political intrigue. It’s a critical question of public health preparedness. How we handicap the probability that a lab could have played a role in the initial contagion informs how we approach efforts to guard against pandemics in the future, including how we design and regulate high-risk labs that handle some of the world’s most dangerous pathogens. We’ve traditionally focused those efforts on trying to reduce the risk of spillover events from zoonotic sources in nature as our primary means to shut off the potential origins of these kinds of catastrophic events. Going forward, to prevent the next pandemic, we have to focus equal attention on improving global lab safety.

To this day, China has never shared the initial strains of SARS-CoV-2, which are key if we wish to firmly establish the virus’s origin. There’s likely never to be a concrete fact pattern firmly establishing where the virus originated, only inferences and a fight over competing narratives. There remains enough evidence to nurture a theory that the initial epidemic may have been sparked by accidental infections that occurred as a result of the poor handling of a lab specimen inside China.

Labs capable of handling the most dangerous pathogens, classified as BSL-4 labs, are being built all around the world, many in countries with a history of poor controls and oversight of research practices. There needs to be an international agency to oversee safety measures at these labs, and what kind of research they’re conducting, because of the well-documented risk that pathogens can escape from research facilities. Yet the global response to COVID may have made the needed cooperation more unlikely. The travel bans imposed on China, and later Europe, conditioned the world on what to expect when a country is host to a new contagion: now, travel restrictions are the new normal. These political conditions make it less likely nations will share early information about future outbreaks, zoonotic spillover events, novel pathogens, or lab accidents. We’ll see more erosion in public health collaboration as an outcome. Countries have even more reason now to hide the embers of the next epidemic.

This is all the more reason why the US needs to lean on the tools of the intelligence community as a way to guard against future threats. Historically, it was always seen as hard to get our intelligence community engaged on these kinds of missions, which were not considered on par with other threats to national security. On the public health side of the ledger, there was equal reluctance to see the intel community take on a larger role in public health response. 

The work of the intelligence community was traditionally seen by the scientific community to run counter to the principles of science, which encourage open sharing of information for the broadest possible public good. The CDC and the public health community were often reluctant to receive classified information and submit to the constraints that came with the handling of such material. And the public health community was sometimes reluctant to share sensitive findings, even in circumstances where the information could help the US adjust its response to a novel threat. During the Ebola epidemic in West Africa in 2014, the CDC signed a bilateral agreement with the government of Liberia to share information, but the agency subsequently refused to give the data it gathered to the US Department of Defense, arguing that its agreement with Liberia prohibited the CDC from sharing the information with “third parties.” The US military was already on the ground in Liberia, as part of a major mobilization to assist in the response to the Ebola outbreak, and the CDC wouldn’t share information that the Pentagon believed could help adjust and guide its response.

Leveraging the eighteen different agencies making up the US intelligence community could provide important new capabilities for reducing the risk posed by naturally occurring pathogens that have pandemic potential. Many public health leaders will worry about a corrosive effect from engaging the tools of national security to achieve missions that were traditionally executed through scientific exchange and multilateral commitments and collaboration. They will fear that this new posture will poison the well of international cooperation. Inside the government, the pushback to a greater role for our spy agencies has often come from the operating components of HHS. Among other things, HHS officials have argued that closer collaboration with intelligence agencies might complicate the overseas activities of public health officials and cause them to be viewed with suspicion when they travel. They worry that everyone with a white coat will be presumed to be a spy. But many foreign adversaries already assume that any American official traveling abroad could be operating on behalf of US intelligence agencies. And the record shows that global commitments, multilateral agreements, and the work of our public health officials weren’t enough to keep us safe. They weren’t even enough to secure access to the source strains of SARS-CoV-2, or early information that the virus in China was spreading human-to-human, had infected healthcare workers, and was being transmitted through asymptomatic infections. 

We need to look across all of our capabilities to make sure that such an event cannot happen again. Other nations are looking to their national security instruments to identify and reduce pandemic risks. We will need to make the same adjustments. Yet, as we go down this same path, we need to make sure we engage our national security instruments in a way that preserves our multilateral institutions and the work of scientific agencies. We need to continue to invest in capacity building in nations with whom we collaborate. We need to make sure that scientific exchange doesn’t become encumbered. Agencies like the NIH don’t want to be burdened with having to handle reams of classified information. Researchers want to know the provenance of any samples they receive and the environment in which it was collected so they can properly assess its usefulness. 

The rules of engagement will need to be carefully worked out.

The flip side is that embedding public health information in our intelligence reporting could elevate the work of our scientific agencies. When it comes to threats from emerging diseases, policymakers aren’t reading academic papers. But they are reading the CIA’s World Intelligence Review and other national security estimates. If more health reporting were regularly included in these assessments and treated on par with other threats, it would keep it in front of policymakers, so they would be in a more informed position to secure the nation against emerging risks.

The components of HHS have access to a lot of knowledge that fits into the national security dialogue, but most of these operating units don’t view this information through that prism. It’s not the world they live in. The national security agencies could help fit this reporting into a broader mosaic that would help identify risks. At the same time, intelligence agencies could better hone their collection and reporting through collaboration with health experts who could provide context to help guide intelligence collection. The National Security Agency scoops up an enormous amount of signals intelligence but may not know precisely what to look for without the help of health experts, or how to interpret the information they gather. If the NSA found itself in possession of sequence data, for example, it might not have a clear sense for how to pull this information out of the signals intelligence or how to make an initial analysis to determine its importance; but collecting these data would fall feasibly into their existing mission given that most of this information is now shared digitally.

Leveraging our intelligence assets to inform us better on risks would also complement our diplomatic tools. More information could be shared with our diplomats to let them target their own efforts around the US public health mission. If intelligence estimates identified certain weaknesses in a nation’s institutions, our diplomats would be in a better position to know where to focus their efforts on capacity building. Perhaps it’s a foreign lab with poor internal controls or certain regions where surveillance is especially weak. These sorts of missions, where diplomatic initiatives are being fed by intelligence agencies, has been a hallmark of arms control efforts, nuclear nonproliferation, and nuclear inspection activities and a similar approach can help improve our biosecurity and surveillance as well.

We need to involve our national security agencies to monitor for these risks, alongside our public health agencies and our multilateral efforts to improve global surveillance.

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