The death of a 28-year-old woman who worked at a plague research laboratory in Siberia on October 2 sparked concern and many questions. Russian officials said the woman died of pneumonia of unknown cause and that there was no "emergency" at the laboratory where she worked. They also said that the health surveillance investigation of his contacts is nearing completion and has not found anything worrisome so far.
The official Russian account contrasts with intense speculation elsewhere about the truth of the incident. Initial unconfirmed reports in local media said the lab worker accidentally broke a test tube containing Yersinia pestis, the bacterium that causes the plague. Several local hospitals, including a maternity hospital, have restricted visitors and stepped up health screenings. A local factory also requires employees to wear masks.
The World Health Organization said that based on available unofficial information, "the public health risk to the general public appears to be low." Indeed, available evidence does not suggest that the world is facing a plague emergency. But this tragic death should prompt Americans to think about our ability to detect and contain the next disease threat in time.
Plague is deadly, but if diagnosed early, it can be treated with antibiotics. The Siberian laboratory worker was rumored to have contracted pneumonic plague. Pneumonic plague attacks the lungs and can be spread from person to person, unlike bubonic plague. Bubonic plague was likely the culprit of the Black Death in the 14th century, and was mainly spread through flea bites.
But even pneumonic plague has relatively limited transmissibility. Historical data shows that one person infected with pneumonic plague infects an average of 1.3 people; in contrast, measles may infect 12 to 18 people in unvaccinated people. There are no records of patients with pneumonic plague spreading the disease before symptoms appear, so caregivers and close contacts are at greatest risk of infection. Wearing masks, contact tracing, isolation, and other established infection control procedures should be effective in limiting the spread of pneumonic plague.
Still, the confidence Russia has provided so far is far from enough, and we still need to find out what exactly is happening in Siberia. Did an accident occur in the laboratory? If so, when was the accident discovered? What treatment did the exposed laboratory workers receive? What prompted authorities to launch massive health surveillance of her contacts? The concerns are driven in part by speculation about biological weapons. The U.S. intelligence community assesses that Russia has a secret biological weapons program. The former Soviet Union included the bacterium Yersinia pestis, which caused the plague, in its biological weapons arsenal.
Unexpected threats from disease can come from many places. It is therefore frustrating that the United States is now so isolated from the international community. Since withdrawing from the World Health Organization in January and recalling American experts seconded to the organization, the United States now has direct access to less information on potential disease emergencies. The dismantling of USAID also severed scientific research collaborations and partnerships that could have helped identify emerging disease threats. Funding cuts and restrictions on infectious disease research have undermined the ability of U.S. scientists to assist the international community in establishing safe laboratory practices. Not only are we reducing access to important public health information, we are also reducing our ability to influence future events.
The Trump administration laid off thousands of staff at the Department of Health and Human Services, including outbreak experts at the Centers for Disease Control and Prevention and the Strategic Preparedness and Response Administration. The loss of these professionals weakens the response capabilities that the United States has spent years building. Investigating and assessing what is going on in an outbreak anywhere in the world requires professional judgment, extensive experience and long-established relationships of trust. No expedient, or even any artificial intelligence model, can replace it. Infectious diseases do not recognize national boundaries.
During the COVID-19 epidemic, U.S. biotechnology and biomedical expertise helped promote the development and application of vaccines, diagnostic tests, and treatments. However, there were serious flaws in the U.S. response to the epidemic, especially the failure to rapidly expand diagnostic testing and the lack of personal protective equipment for medical staff in the early stages of the epidemic. We should have continued to build on our existing capabilities and correct these mistakes. Yet we are weakening our public health infrastructure while hundreds of thousands of Americans, including many children, are struck by preventable infectious diseases like measles. We are also weakening our preparedness to deal with potential future threats, such as H5N1 influenza, also known as bird flu. The virus was recently detected on a mink farm in the United States, and it remains a potential pandemic pathogen. The Trump administration also canceled a contract to develop an H5N1 messenger RNA vaccine for humans.
The lesson this unexplained death in Siberia should teach us is that responding to disease emergencies requires evidence, expertise and cooperation. We must continue to invest in tools to investigate and control outbreaks. Most importantly, we must invest in the professionals who can apply these tools.
