September 21, 2020

The Niche

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Mixed messages on CRISPR babies from National Academies versus their experts: a look at new Science piece

National Academy CRISPR Baby article
Screenshot from National Academy Science article on CRISPR Baby issue.

Three national academy leaders have a new opinion piece in Science on what the community needs to do next regarding human germline editing now that we are most likely in the CRISPR babies era.

Some of us have been wondering what the Academies and their empowered experts really think about this issue and what they are saying outside the public domain. Do some of them disagree with each other? There have been mixed messages.

The new piece, entitled, Wake-up call from Hong Kong, gets a lot of things right in my view, but could have gone much further.

It rightly expresses a sense of urgency about the need for more action. The authors of the piece, Victor Dzau (President of US National Academy of Medicine), Marcia McNutt (President of US National Academy of Sciences), and Chunli Bai (President of Chinese Academy of Sciences) focus on the need for international cooperation and consensus on how to handle this complex area. Waiting 3 years for another (the third) international meeting on human genome editing in 2021 is too passive a route for a complex, quickly evolution situation like this. The authors clearly get that.

I appreciated that this particular statement is also stronger than some of the past:

“To maintain the public’s trust that someday genome editing will be able to treat or prevent disease, the research community needs to take steps now to demonstrate that this new tool can be applied with competence, integrity, and benevolence. Unfortunately, it appears that the case presented in Hong Kong might have failed on all counts, risking human lives as well as rash or hasty political reaction.”

However, overall it seems like this article doesn’t go quite far enough. I also believe that the Academies’ groups of experts/meeting organizers are in some cases themselves causing potential issues in certain ways via their conflicting statements.

For instance, one issue at the recent international human genome editing meeting in Hong Kong was that even in the context of He Jiankui’s statement claiming (we still don’t know if it’s true by the way) production of CRISPR’d babies, some of the meeting organizers spoke about the need not to restrict human germline editing or even seemed to advocate forging ahead quickly. As much as the organizers of this particular meeting collectively then issued a stern statement at the end about how what He did was bad and they discouraged others from following suit, overall they overall sent a mixed message.

There has even been speculation that certain meeting organizers or other experts are secretly happy (or at least have mixed rather than entirely negative feelings) about what He did because it “broke the ice” even if it also caused a lot of commotion and wasn’t done well. I’m not sure I buy this idea, but at the same time we can’t rule it out entirely because of the mixed messages.

I personally favor a temporary moratorium of 3 years on making CRISPR babies because although it’s not perfect, it is clear and very low-risk. It’s also not going to impeded lab research at all. Note that I’m not alone on this general idea as CRISPR pioneer Feng Zhang has also publicly called for some kind of moratorium.
The three academy leaders end their new Science piece on this note:

“We need to build upon the work done at recent international summits and the guidance provided by numerous organizations to achieve broad agreement on specific standards and criteria for human germline genome editing research and clinical applications—agreement that should include not only the scientific and clinical communities, but also society as a whole.”

But what if academy members and meeting organizers can’t even agree amongst themselves?

Furthermore, what if broad consensus from the wider, diverse community is in favor of a temporary moratorium, but many of the Academy leaders don’t want one? If the Academies go with their few experts over the wider community then I think we have a problem.

On the other hand, perhaps the wider community agrees with the experts on not even wanting a temporary moratorium on implantation of CRISPR’d human embryos? Maybe. I don’t think we have a very clear sense of the broader views on CRISPR babies within the diverse research community yet.

In the end, the scientific community cannot stop a few rogue actors from making more CRISPR babies even with a moratorium, but we can send a much stronger, more consistent message that human germline editing should not be done at least at this time or in the near future.

Why should we do this?

In my view, such a strong stance actually helps CRISPR research overall including that focused on somatic gene therapy where there are already promising clinical trials.

There is also a clear lack of a compelling medical need for CRISPR babies (don’t forget PGD), there are sizable gaps in our understanding of gene editing in human gametes and early embryos that make it very risky at this time, and there are definite known risks such as off target effects and mosaicism that in reality haven’t been resolved and won’t be as soon as 2019.

There are also thorny ethical, societal, and specifically social justice issues related to making heritable mutations in humans via CRISPR. I am definitely glad the Science piece reinforces the need for societal involvement and agreement as that wasn’t stressed by the organizers of the latest meeting.

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