The hidden scale of laboratory accidents: The need for transparency and engagement

Reducing opportunities for human error must be a top policy priority to reduce the risk of potentially catastrophic laboratory accidents involving high-consequence pathogens.

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Recent global health emergencies have exposed the vulnerabilities that arise from inadequate capacity and capability to detect outbreaks rapidly and contain them before they escalate and spread uncontrollably. 

For example, the West Africa Ebola outbreak of 2014-16 and the COVID-19 pandemic not only killed thousands and millions of people respectively, they also devastated economies and undermined global health security. 

Laboratories are a crucial part of the system for disease surveillance, helping to detect outbreaks early, assist a robust response and recovery, and carry out research to improve protection against threats from high-consequence pathogens. 

For laboratories to fulfil that role, effective biosafety and biosecurity measures are an absolute priority. 

Biosecurity measures to prevent the deliberate malicious use of pathogens continue to receive international attention, though much remains to be done.

The issue of accidental breaches in laboratory biocontainment has been neglected by the international community

By contrast, the issue of accidental breaches in laboratory biocontainment has been comparatively neglected by the international community. Such breaches pose an underappreciated and potentially significant risk to global health security. 

However, concern over the possibility and implications of such accidents has been brought into sharp focus more recently with speculation regarding whether the COVID-19 pandemic might have originated from a laboratory accident in Wuhan in China. The source of the pandemic remains undetermined. 

The scale of accidental breaches

The first global investigation into reported accidents shows the scale of the problem.

New research investigating reports of human and animal laboratory accidents concludes that worldwide recording and reporting of occupationally acquired infections among laboratory workers is poor.

So too is reporting of accidental pathogen escapes from laboratories into communities – and their causes. 

Many countries have no reporting requirements, which means that what is reported certainly understates the scale of the challenge. In addition, when accidents are reported, the quality of the information provided is often suboptimal, even in well-resourced countries. 

Of the accidents captured in the research, nearly 70 per cent of known causes were due to avoidable human error

Of the accidents captured in the research, nearly 70 per cent of known causes were due to avoidable human error. 

The leading reported cause was inappropriate procedures, such as incorrect selection or use of personal protective equipment or primary containment equipment, inadequate training, and mishandling of specimens. 

Other important causes included needle-stick injuries, animal bites and scratches, suspected exposure to aerosols, and engineering failures because of inadequate facility maintenance.

The threat of inadequate reporting

The finding on the proportion attributable to human error is a cause for both concern and hope. 

Of great concern is the current state of laboratory accident reporting and analysis. Poor and incomplete information makes robust assessment and tracking of the problem, and the success of efforts to address it, impossible. Transparency is critical to understanding and mitigating the risks.

International agencies have issued updated good-practice guidance on biosafety for human and animal laboratories that takes a risk-based rather than a one-size-fits-all approach, but in many countries there is insufficient capability and capacity to follow such guidance.

In addition, there are often inadequate expertise and resources to implement safe practices and to maintain facilities as required.  

Sustainability

Lapses in laboratory biosafety and biosecurity are also more likely if laboratories are not sustainable.

The Ebola outbreak in West Africa and the COVID-19 pandemic have led to considerable investment by the international community to bolster diagnostic laboratory capacity and capability in low-resource countries.

While having more laboratories should increase the likelihood of rapid detection and control, it is unclear how sustainable this increased laboratory capacity and capability might be. 

The sustainability of laboratories is intimately linked to having a skilled workforce to run them and the ability to maintain the facilities themselves

The sustainability of laboratories is intimately linked to having a skilled workforce to run them and the ability to maintain the facilities themselves. 

Laboratories built with international partners in low-resource settings very often use the assumptions, templates and standards applied in high-income countries. These can be difficult or even impossible to sustain in low-resource environments because they are too expensive and complex to run reliably, and not sufficiently adaptable to local conditions. 

Problems that can be tackled

Without more systematic reporting and root-cause analysis of laboratory accidents and near-misses, without investment in the right kind of training to reduce human error, and without innovation in sustainable laboratory design, efforts to improve laboratory biosafety and biosecurity will remain compromised. 

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There is hope though, because each of these aspects can be tackled and to some extent are already being confronted. But much more can and must be done to reduce the drivers and enablers of laboratory accidents.

Addressing inadequacies in documentation and reporting of accidents will require both political will and financing.

Systematic reporting and analysis of accidents would provide a more accurate understanding of the scale of the problem and where efforts need to be targeted – but early consideration must be given to whether a global reporting norm should be established, and whether enforcement or verification mechanisms are needed. 

Efforts to address the shortage of skilled personnel to conduct risk assessments and implement risk-based biosafety guidance… need to be scaled up dramatically to reduce human error

Efforts to address the shortage of skilled personnel to conduct risk assessments and implement risk-based biosafety guidance are ongoing but need to be scaled up dramatically to reduce human error.

Particular attention has to be paid to retention of those already trained, from risk assessors and laboratory workers handling pathogens to managers responsible for oversight and bioengineers tasked with equipment calibration and maintenance. 

Innovation in laboratory design to make context-appropriate facilities will enhance sustainability and support better biosafety and biosecurity in all settings. 

Organized international efforts to address this aspect are just beginning, tapping into the ideas of innovators in low-resource settings and underwriting the piloting and scaling-up of the best proposals. 

Even with an adequately resourced multi-faceted approach that focuses on the key drivers, the probability of laboratory accidents occurring can never be reduced to zero – but there is considerable scope to curtail them substantially and to minimize the prospect of catastrophic outcomes.