The National Emerging Infectious Disease Laboratories at Boston University have the latest equipment, security redundancies, and airtight procedures and protocols. Yet, as they begin work on Ebola and Marburg, they cannot eliminate the risk of human error.
When it comes to biomedical research, Boston, Massachusetts, is the place to be.
“This is truly the biomedical mecca of the United States,” said Ronald B. Corley, PhD, director of Boston University’s (BU) National Emerging Infectious Disease Laboratories (NEIDL).
Although that may sound like something written by the chamber of commerce, it’s hard to dispute that the metropolitan area that is home to BU, Tufts, Harvard, and the Massachusetts Institute of Technology, has an uncommonly high concentration of the world’s leading medical and scientific experts.
Perhaps it was no surprise then, that when the National Institutes of Health sought grant applications from facilities hoping to study emerging infectious diseases like Ebola, a Boston lab was one of the winners.
Dr. Corley said NEIDL’s success in the grant application has everything to do with location.
“They were looking for a couple of things in the application; one was compelling support for emerging infectious disease research,” he told Contagion®. “The second was the opportunity to build these facilities and have research activities on medical campuses.”
BU checked off both of those items and was awarded a grant equal to 75% of the total cost of building the facility, which Corley said will be about $197 million.
The award was a feather in BU’s cap, and a chance for leading infectious disease and health care analytics experts to work closely together on vitally important public health issues.
Despite these accolades and opportunities for research and development, the grant also created concern among some neighbors who worried that the facility’s designation as a Biosafety Level 4 (BSL4) facility would bring some of the world’s most dangerous pathogens and toxins into the heart of a metropolitan area of more than 4.5 million people.
Those concerns became a reality this month when NEIDL announced it had received samples of the Ebola and Marburg viruses and would begin studying them.
Lynn Klotz, PhD, senior science fellow at the Center for Arms Control and Non-Proliferation, said the arrival of Ebola in Boston, even in a highly secure laboratory setting, is worrisome. That is because if a laboratory worker got infected—say, by an accidental needle prick—they could quickly infect many others once they leave work and, for instance, take mass transit.
“They get infected, and they don’t know they’re infected,” he said. “They could spread it to strangers and once it’s spread to strangers you don’t know who was exposed to it.”
The situation is particularly an issue with Ebola because symptoms may not show up until up to 21 days post-infection, he noted. On the other hand, Dr. Klotz considers influenza strains as considerably more dangerous than Ebola, and he noted that the United States’ strong public health system would likely contain any Ebola outbreak relatively quickly.
Standing between the Ebola and Marburg viruses and the general public is arguably one of the most intensive biosecurity apparatuses ever assembled. The facility is equipped with the latest high-tech laboratory equipment, backup power, and redundant steam sources. Officials reviewed security breaches and laboratory incidents at similar facilities around the world and used those mistakes to inform their planning for the new facility. Furthermore, because of its BSL4 designation, the laboratory has to meet certain state and federal security guidelines designed to keep it safe from potential terrorists or other criminal activity.
Dr. Corley said NEIDL undertook an unprecedented 5-year risk-assessment process which demonstrated that these laboratories “are incredibly safe, and the only potential risk is to the scientists that are doing the work.”
A group called Roxbury Safety Net, which opposed the creation of the NEIDL, was advised by Dr. Klotz. Now that it’s here, though, Dr. Klotz agrees that the facility likely has the best security measures and procedures possible. It’s just that he doesn’t believe the best procedures can eliminate the risk.
“The truth of the matter is 75% to 90% of all incidents and accidents in laboratories are due to human error and human error can outweigh mechanical error,” he said.
Dr. Corley doesn’t disagree.
“I think human error is always probably at the top of any concerns that you have,” he said. “[Therefore] one of the things that is done regularly is regular trainings. We are constantly keeping safety and security at the top of everyone’s memory and concerns.”
Saskia Popescu, MPH, MA, CIC, an infection prevention specialist and PhD candidate studying biodefense at George Mason University, said researchers have multiple incentives to follow security and reporting protocols. For one thing, they risk jeopardizing their funding—or their lives—if they do not keep facilities secure.
“People don’t work in BSL4 labs without a sense of awareness for the work they do—they are dedicated to the work and willing to risk their lives. It’s not something they take lightly,” she said.
In fact, Ms. Popsecu, a member of the Contagion® Editorial Advisory Board, said often it’s the low-security facilities that pose the greatest risk.
“Sure, these facilities have deadly diseases such Ebola, but you know what worries me more? Hospitals,” she said. “I see hospitals as bigger areas of risk if people really want to get ramped up about infectious disease threats (especially considering how they have acted as amplifiers for SARS and MERS, not to mention highly-resistant infections).”
Dr. Corley added that his researchers take their work seriously and the facility has strong procedures and review protocols in place.
“Any time you have a glove breach you report it, and then our infectious disease team assesses that breach to determine whether it’s high-risk or low-risk and how the person should be followed up (with),” he said. “That includes staying home or going into a special pathogens unit.”
Insofar as human error does occur, the Boston Public Health Commission has said it will closely monitor the facility and be transparent about safety breaches and incidents. The commission has years of experience regulating BSL3 facilities. That means the public will have a good idea of how often problems occur at NEIDL, and what the lab or the commission does to mitigate those risks.
Of course, publicizing errors and incidents could also have a negative effect, as it could create the impression that the public is at risk, even if that is not true. Dr. Corley shared that he believes transparency is essential, and that the benefits of being open outweigh the risk of misinformed anxiety.
“I have learned that the only way to build trust is to be transparent and open and have open, respectful conversations even with the opponents,” he said.
He added that when NEIDL has been transparent about past incidents, they found that other researchers from other labs came forward to share similar experiences and they worked together to solve such problems.
Dr. Klotz, whose research involves closely tracking incidents and breaches, said the public should be most concerned about influenza strains, like the avian flu. He noted that, likely for historical reasons, much of the research into dangerous influenza strains is happening at BSL3 facilities, one security level lower than NEIDL.
Although Dr. Klotz and the concerned neighbors were unable to stop the siting of a BSL4 emerging infectious diseases laboratory in Boston, he said he now wants to ensure both NEIDL and the Boston Public Health Commission live up to their pledges of transparency.
“I intend to keep a close eye on things and I want to get to the Boston Public Health Commission to really make sure that they are going to be as transparent as they say they will be,” he said.