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“The Power of We” is a personal tribute to the individuals and organizations that collaborated in the discovery and advancement of knowledge of the hantaviruses following the original isolation of Hantaan virus by Ho Wang Lee. It focuses on the work done primarily at the United States Army Medical Research Institute of Infectious Diseases during the decade of the 1980s under the leadership of Joel Dalrymple, who worked in close partnership with Ho Wang Lee. These early studies helped define the global distribution of Seoul virus and provided seminal information on its maintenance and transmission among urban rats. Other collaborations involved partners in Europe, Asia, and Latin America and resulted in the isolation of novel hantaviruses, a better understanding of their global distribution, and validation of diagnostics and therapeutic interventions for treatment of human diseases. By working in partnership, scientists from around the world made critical discoveries that led to a better understanding of the hantaviruses. “The Power of We” demonstrates that we all benefit when we work together with a shared vision, a common commitment to excellence, and mutual respect.

The current outbreak of Ebola virus in the Democratic Republic of the Congo is a reminder that dangerous diseases exist in many corners of the world and that they can cause substantial human suffering and financial devastation locally and internationally. In response, institutions and nations are constructing maximum biocontainment laboratories (MCLs) to address these threats. MCLs operate at the highest level of biological containment to diagnose, perform research on, and validate cures for life-threatening diseases like Ebola. There are more than 50 MCLs that are operational, under construction, or in advanced planning around the world. The global proliferation of these facilities raises questions about how to ensure their safe and secure operations while enhancing their contributions to science and global health. One solution is to establish an MCL network that enables the sharing of best practices, collaboration, transparency, and exchange of specimens and technology.

When the International Health Regulations (IHR) came into force in 2007, WHO announced that “the global community has a new legal framework to better manage its collective defences to detect disease events and to respond to public health risks and emergencies”.1 The IHR aim to enable the prevention, detection, and containment of health risks and threats, the strengthening of national capacities for that purpose, and the coordination of a global alert and response system. [...]many countries only applied the IHR in part, were not sufficiently aware of these regulations, or deliberately ignored them,3,4 and that WHO did not make full use of the powers given to it through the wording and spirit of the IHR. [...]the IHR are not deficient, but their implementation by member states and by WHO was inadequate. There was a marked lack of national responses both to WHO's first alerts—eg, published risk assessments and guidance on public health response and statements by the WHO Director-General—and to the Public Health Emergency of International Concern declaration.

The human and economic toll of the coronavirus disease 2019 (COVID-19) pandemic and the unknowns regarding the origins of the virus, with a backdrop of enormous advances in technologies and human understanding of molecular virology, have raised global concerns about the safety of the legitimate infectious disease research enterprise. We acknowledge the safety and security risks resulting from the broad availability of tools and knowledge, tools and knowledge that can be exploited equally for good or harm. The human and economic toll of the coronavirus disease 2019 (COVID-19) pandemic and the unknowns regarding the origins of the virus, with a backdrop of enormous advances in technologies and human understanding of molecular virology, have raised global concerns about the safety of the legitimate infectious disease research enterprise. We acknowledge the safety and security risks resulting from the broad availability of tools and knowledge, tools and knowledge that can be exploited equally for good or harm. The last 2 decades have shown us that the risks are real. They have also shown us that more traditional top-down regulations alone are not the answer. We encourage government to be thoughtful and nuanced in dealing with this significant challenge and to carefully consider human factors and the important role of organizational-level leadership before simply layering an additional bureaucratic burden on the enterprise without understanding value and cost.

Personal protective equipment (PPE) is an important part of worker protection during filovirus outbreaks. The need to protect against a highly virulent fluid-borne pathogen in the tropical environment imposes a heat stress on the wearer that is itself a safety risk. No evidence supports the choice of PPE employed in recent outbreaks, and standard testing procedures employed by the protective garment industry do not well simulate filovirus exposure. Further research is needed to determine the appropriate PPE for filoviruses and the heat stress that it imposes.

The current crisis with the Ebola virus vividly illustrates the priority that must be given to infectious diseases because of their potentially devastating consequences to individuals and to society. Few would argue against the need for more research on Ebola and the expedited development of a cure; however, recent incidents in biocontainment laboratories and the proliferation of such facilities globally raise concerns about safety and have split the scientific community. Scientists who defend research on dangerous pathogens as vital to protecting populations are opposed by those who fear the potential devastation caused by the intentional or unintentional release of pathogens from the lab. Achieving a “culture of safety,” so often alluded to after recent lapses in biosafety procedures, demands adopting a “culture of responsibility” as well.

An outbreak of severe hemorrhagic fever with renal syndrome (HFRS) occurred in 1988 in Pozarevac, Serbia, Yugoslavia. The disease was diagnosed in 4 children and I adult, and I of the children died. Rodents were captured from the same area and virus isolation attempted. A hantavirus, POZ-M1, was isolated from lung tissues of hantavirus antigen-positive Mus musculus. Serology and restriction enzyme digestion of polymerase chain reaction-amplified segments from this virus showed that it was a strain of Puumala (PUU) virus, the causative agent of nephropathia epidemica. While Clethrionomys glareolus is the major rodent host for PUU virus, these results suggest that M. musculus may also play an important role in harboring and transmitting PUU-like viruses. The serologic association of this virus with patients with severe HFRS reaffirms that PUU-like viruses may cause severe disease in addition to the generally mild form normally associated with nephropathia epidemica.