WILMOT JAMES AND ANDREW ILIFF: Seizure of Khartoum’s laboratory triggers upscaling of biosecurity

The world avoided an acute health threat narrowly last month recently, and few noticed. 

In late April, the National Public Health Laboratory in the Sudanese capital of Khartoum fell into the hands of one of the warring parties. The director of the laboratory, Shinaz Bedri, reported that a few days before armed groups entered and ordered security staff trained to handle emergencies to leave.

“We are worried that there might be a bio risk if they open fridges, because they go in and they sabotage,” said Bedri.

The World Health Organisation’s (WHO's) representative in Sudan, Dr Nima Saeed Abid, who was evacuated from Khartoum, said that the main concern is that lab technicians could not get into to the lab to “safely contain the biological material and substances available”. In other words, without laboratory staff ensuring proper safety protocols people were likely to be exposed to infectious samples in a volatile environment made worse by lack of access to food, clean water and sanitation.

Had this been another laboratory, it could have been catastrophic. For good scientific reasons, many laboratories around the world, usually high containment ones, study highly dangerous pathogens. This includes entities that conduct confirmatory testing for dangerous diseases and  research on disease agents. A fatal outbreak could follow, accidentally or deliberately, if such a laboratory fell into the wrong hands.

Laboratories such as these require technicians to take precautions, including routine biosafety and security precautions as well as inactivating samples or destroying them in unstable times to avert accidental or deliberate pathogen release.

The Khartoum laboratory may be different, but on a national level Sudan does not have strong biosafety or biosecurity systems and safeguards in place. The WHO’s Joint External Evaluation (JEE) established in 2016 said that Sudan had “no national record or inventory of pathogens within facilities that store or process dangerous pathogens and toxins and what they house”.

Five years later, the 2021 Global Health Security (GHS) Index found no evidence “that Sudan has in place a record, updated within the past two years, of the facilities in which especially dangerous pathogens are stored or processed, including details on inventories and inventory management systems of those facilities”.

JEE found in 2016 that there is “no national training programme in biosafety and biosecurity for all laboratories in all sectors”. By 2021 the GHS Index found “no evidence” that Sudan requires continuing biosafety and bio-security training. The table shows the scores (0 indicating nonexistent and 100 fully developed) for key biosecurity and biosafety factors at play.                                                     

This is the national picture. It may be that the Khartoum laboratory, the premiere health laboratory for the country, had some guard rails in place (the laboratory director did say her staff were “trained to deal with emergencies”). The African Society for Laboratory Medicine has also been working in the Sudan region on biowaste management and incineration capacity. 

Still, the fate of this laboratory has three important lessons for our global biosecurity system:

• It is vital for governments to understand where dangerous pathogens are housed and what work is being done in those facilities;
• Biosafety and biosecurity protocols are critical, including protocols to reduce risk when instability strikes; and
• Governments and donors must invest in biosafety and biosecurity within national health institutions if they expect to avoid deliberate or accidental biological events.

The first lesson is about the risk inherent in the rapid construction of laboratories, and the gaps in knowledge of the samples they hold, the protocols and precautions used to keep those samples secure, and adherence to these protocols. We need improved, more comprehensive biosecurity data urgently, and cybersecurity measures to protect the data itself from misuse.

The second lesson is about the shortcomings of our existing biosafety and biosecurity protocols. Biosafety and biosecurity are among the lowest scores worldwide when countries assess their pandemic preparedness capabilities, yet there are consistently few funding sources for improving capacity or rightsizing risk. Broadly, biosafety refers to efforts to prevent accidental exposures, while biosecurity protocols are directed against deliberate efforts to deploy biological threats. Control of the Khartoum laboratory’s samples falls between these two regimes, with exposure due to conflict, not accidental oversight or targeted attack, and points to the need for improved fail-safe mechanisms that can be deployed in the case of general security threats.

Finally, the loss of the Khartoum laboratory teaches us that our global institutions are not adequate to the task of tracking and investigating biological threats as they develop in real time. Biosecurity allegations can be investigated by the UN secretary-general’s Mechanism for Investigation of Alleged Use of Chemical and Biological Weapons, at the request of a member state, but to date the mechanism has only investigated the use of chemical weapons. Inadvertent release falls in a grey zone between these two regimes.

Two proposals aim to fill this gap by creating systems for quickly investigating outbreaks of uncertain origin. One, proposed by the Nuclear Threat Initiative, would create a new joint assessment mechanism housed within the office of the UN secretary-general, which could leverage other capabilities across the UN to investigate biological events of uncertain origin.

An alternative proposal would create a free-standing international biotech organisation mandated to respond to a wide range of biological events, as well as to implement early warning systems, in collaboration with the UN and WHO. Either proposal would help secure the world in the face of proliferating biological laboratories and the resulting risks.

Biological laboratories are essential infrastructure for health security. Without them we are unable to identify and track biological threats, or develop and test countermeasures. However, the recent proliferation of laboratories around the world — particularly those working on dangerously infectious or virulent pathogens — has exposed grave gaps in our biosecurity systems. King’s College Filippa Lentzos says “there has been a global boom in construction of labs handling dangerous pathogens, but this has not been accompanied by sufficient biosafety and biosecurity oversight”. Her recommendations to strengthen biosecurity at laboratories that handle high-consequence pathogens include:

• That labs conducting high-consequence work with pathogens adopt the international standard for bio risk management
  (ISO 35001);
• Countries incorporate current international bio-risk management standards into their national legislation and guidance; and
• Countries better leverage existing international bio-risk management organisations to strengthen global bio-risk management.

Discussion about accidental laboratory release has increased after the focus on the origins of the Covid-19 pandemic, yet this attention has not translated into practical and necessary steps to address the shortcomings present in labs around the world. Effective response requires mobilisation in the face of lesser threats, like that posed by the loss of control of the Khartoum lab, as drills that help test and build our readiness to address some of the greatest threats humanity faces.

The Africa Centres for Disease Control and Prevention has had an extensive biosecurity and biosafety initiative in play since 2018, but as a continental technical support agency it relies on individual countries to act and take appropriate measures.

• James is professor of health policy, services & practice, and senior adviser to the pandemic centre at Brown University’s School of Public Health. Iliff is dean’s senior writer at Brown University’s School of Public Health.