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DW's Anthony Howard speaks to Dr. Amesh Adalja, a scientist at the Johns Hopkins University's Center for Health Security. He calls on Russian authorities to release more details of the case.
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00:00A remote city in Russia, an institute that studies some of the world's most dangerous diseases,
00:05a 28-year-old laboratory worker suddenly dies, and a series of extraordinary measures that have
00:12followed. That's the story we're looking into today, taking us to Siberia, the city of Irkutsk.
00:19At the centre of it is the death of a laboratory technician who worked at the Irkutsk Anti-Plague
00:26Research Institute of Siberia and the Far East. Much about this case remains unclear,
00:32and so far Russian authorities have provided only limited information. But here's how events
00:38reportedly unfolded over the past few days. Now, according to reports by Russian media,
00:45the worker may have accidentally broken a test tube containing plague bacteria on September 25.
00:51Four days later, she was reportedly admitted to hospital after falling ill. Then on October 2nd,
00:58she reportedly died. That same day, the hospital where she was treated was placed under quarantine.
01:04On October 3rd, a nearby aluminium plant introduced a mask mandate. On October 4th,
01:10Russia's public health agency said the woman had died from what it called
01:14pneumonia of unknown etiology. That means unknown origins. And today, the Kremlin urged the public
01:20not to pay attention to what it called rumours and speculation surrounding the case.
01:26Now, the rest of the world is watching closely to see what is happening in Siberia.
01:30US President Trump said the outbreak was a big problem for Russia,
01:34and that the US would be willing to help with the situation. But so far, the international community
01:40relies on whatever information is coming out of Russia, as the US Secretary of State Marco Rubio
01:46pointed out earlier today.
01:48Well, we don't we know what we know, obviously, about whatever the Russians have provided,
01:52which is it seems that there was a worker at the lab that was infected. And there's concern that
01:58that, you know, could have spread, at least internally. So you see them do quarantine to that's in that
02:04or that nature. There's very limited travel between the US and Russia, obviously. But like anything
02:10else, something like that gets out, it could quickly spread. So we're watching and monitoring
02:13it closely. Yeah, I don't think it's cause for alarm, but it is cause for focus, and a cause to
02:18just keep an eye on it. And we're doing that.
02:20So a lot more questions than answers at this point. Good thing we've got Dr. Amesh Dalja. He's a senior
02:27scholar at the Johns Hopkins Center for Health Security, and an expert on emerging infectious
02:32diseases in biosecurity, having served on US government panels that develop guidance for
02:37responding to plague outbreaks and other high consequence biological threats. Amesh, great
02:43of you to join us. A lot of speculation centers on the pneumonic plague. What exactly is the
02:50pneumonic plague? And how different is it from the plague that people know from history books?
02:56Well, it's part of that whole constellation of diseases that we call the plague. They're all
03:01caused by the same bacteria, Yersinia pestis. And when it is localized to your lymph nodes,
03:08we call it bubonic plague. Those lymph nodes swell. They were called buboes, so bubonic plague.
03:14When it's in your lungs, that's what we call pneumonic plague. Pneuma means air. So pneumonic plague
03:21in your lungs, that's the one that can be transmitted from person to person. And that's the one that's
03:27more dangerous, has a higher mortality rate. But remember, we're now in the 21st century, not
03:32the 14th century. So both pneumonic and bubonic plague are eminently treatable with antibiotics,
03:40granted that if they're antibiotic susceptible. So this isn't the same calamity that our ancestors
03:46faced during the Black Death. And it's unclear even whether this person in Siberia actually died of
03:52plague. I actually don't think there's enough evidence to say she died of plague. There's something
03:56else at play here. If someone does contract the pneumonic plague today, how dangerous is it?
04:04How does it spread and how effective are modern treatments for it?
04:10So in the United States, half of our country, the entire western half of the United States is what
04:15we would say plague endemic, meaning the rodents that live in Arizona, California, they harbour the
04:21plague bacteria. So people get it from usually exposure to one of those rodents, exposure to
04:28their fleas. And recently, people in the United States have been getting it through exposure to
04:33cats who have gotten it from rodents or from fleas. And then the cats get ill and infect their owners.
04:38It is a severe pneumonia with maybe a case fatality ratio of around 10%. And that fatality rate is largely
04:46driven by the fact that people don't recognize that it's plague. We do have highly effective antibiotics
04:51for plague. But if it is misdiagnosed, they won't get the right antibiotics. And they end up getting a more
04:58severe illness. Just last year, we had a fatal plague case in Arizona in the United States. So it's not
05:04something that ever left the world. What changed is humans develop tools to cope with the plague, which is why
05:11what's happening in Russia seems so out of character, because plague is a well-characterized pathogen
05:16with well-characterized treatment pathways. They're not acting like it's plague. They're acting like it's
05:22something different with what they're doing in terms of monitoring all these contacts and the like.
05:27That doesn't, that's not congruent with plague.
05:30Right. I'm sure the question on everyone's lips is whether or not we have the likelihood that we're
05:36heading into something like another global pandemic. Let's hold on to that thought for now,
05:40as we'll come back to you. As we reflect on the immediate response, you talked about the
05:44response in Russia. Let's bring up some of the key quotes from the Russian Health Agency regarding
05:50this case. The first says that the woman was diagnosed with pneumonia of unknown etiology.
05:57That means unknown origin. And they say the testing found no microorganisms associated with the
06:04patient's professional activities. When Russian authorities say they found no evidence linking
06:12this woman's illness to her work, how much confidence should outside observers place in those statements?
06:22I don't know how to evaluate those statements. So does that mean because she works at an anti-plague
06:28center that this isn't plague, but is it something else that's kept at that lab? It's not something
06:35that she directly works with, but something else that might be at that lab? Is this something she
06:38contracted in the environment, in the community? All of that needs to be much more transparent.
06:44What I would like to see is Russian public health authorities talk about what they do know,
06:48what they ruled out, what they are thinking may still be a possibility, what the clinical course
06:54was of this patient. All of that needs to be out there to have any kind of understanding of what
07:00happened. And when you think about these anti-plague institutes in Russia, many of them served two
07:08functions. One was to deal with plague that was endemic in Russia, and the other was to work on
07:14biological weapons problems. And I don't know what was going on in that place. So I think everything
07:19that they say, you have to take with healthy skepticism, because this is a country that had a
07:26clandestine biological weapons program for decades and decades. This is a country that has weaponized
07:33organisms, including plague, including making it antibiotic resistant. So all of that kind of
07:40colours the way I take the Russian statements. Yeah. And until we get more information, we're left
07:46to fill in that vacuum or that gap. And so we turn to you. Whenever a laboratory worker becomes ill,
07:52people immediately wonder about a possible lab accident. In general terms, how often do incidents
07:59like that happen in high security laboratories? So in general, when you're working in a lab,
08:07there's going to be lapses that occur. Most of them are going to be innocuous and not result in
08:10anything. In places where you're working with high consequence infectious diseases, high consequence
08:17pathogens, there are multiple different layers to prevent those types of accidents from happening
08:21and to intervene very rapidly when an accident might occur. So these aren't things that we see
08:28every day happening in BSL-3, BSL-4 labs, the highest levels of biosafety, but they do occur.
08:36And there's usually a massive plan, a very extensive plan when it does occur to prevent any negative
08:43consequence from happening, which again, points to some inconsistencies in this story, because if it
08:49were plague, there's a clear protocol that you use if someone's exposed to plague. And presumably they
08:55would know because she's working at an anti-plague institute. So again, that's another piece of this
09:00puzzle. Why the whole idea of plague was even floated as a possibility, because that wouldn't be
09:05something that would be hard for an institute like that to intervene upon. Yeah. How common is plague in
09:13Russia and Siberia today? And why is it still being monitored so closely?
09:20So it is still common in those areas, especially near the Mongolian border where she was. That's kind
09:25of the natural or historical home of plague is that area of the world is what people hypothesize.
09:31So it is still common. Plague is still common all over the world. I mentioned the western part of the
09:36United States. There are parts of Africa and Asia also that have plague. So this isn't something that
09:41ever really left. It just doesn't cause things like the Black Death anymore. So these anti-plague
09:48institutes, they do more than just study plague. I think that's kind of a generic term they use
09:53for a biolab that works on many different infectious disease problems, including emerging
09:58infectious diseases and newer things. But they still kind of carry that label of anti-plague
10:04institute because that was the historical reason that these labs were set up kind of in the frontiers
10:09of the Soviet Union. This is your field of expertise, but one of those moments when the rest of the
10:15world gets a window into something they might not have realised still exists. Why do anti-plague
10:21institutes like the one in Kut's still exist today? What is their primary function and what work are
10:29they typically doing at this point in 2026?
10:33Just because it's labelled anti-plague doesn't mean that's the entire and exclusive focus of one of
10:37those institutes. They may be doing work on plague because it is still a problem. We still don't have
10:43a good plague vaccine. There are still questions about drug-resistant plague. Those are legitimate
10:48areas of research. But they also work on other emerging infectious diseases outside of plague.
10:53So there's many different infectious diseases that the world is coping with. And these anti-plague
10:59institutes do some of that work as well. I think people get stuck on the name anti-plague institute.
11:05They're really basically just biological laboratories that are doing research on various different
11:11infectious diseases. And hopefully all of that is above board. But in the past, some of those
11:17institutions in the Soviet Union were clandestine bioweapons entities.
11:24Okay. So the coronavirus is now a distant memory most of us would rather forget. At this point,
11:31while we're talking about these viewer-type questions, I guess you're going to get a lot
11:35today. But it did leave coronavirus quite an impression on us. How likely is it? Is there
11:40a danger that events like this can lead us back into that type of pandemic territory?
11:47So I think post-COVID-19, there's this tendency to view every infectious disease story through the
11:54lens of COVID-19. And each infectious pathogen has different characteristics, different levels of
12:01pandemic potential. Some have zero, some have high pandemic potential. But they're all sort of
12:06getting lumped together, often in the media and often in the public's mind. But what I would say is
12:12that we will face other pandemics, and humans will face them. Avian flu comes to mind really
12:19quickly. That's the biggest pandemic threat we face. But I don't think that what we're seeing in
12:24Russia is the beginning of a pandemic. There's not enough information to say anything like that.
12:29We don't actually know what's going on. So I think the more prudent thing to do is really push the
12:35Russians to talk about what actually this is, what they know, what they don't know, and to allow
12:40outside investigators from the World Health Organization, for example, to help, to help run
12:46this down. So we can stop some of this speculation. Because not every infectious disease threat,
12:52even if it's serious, rises to the level of a pandemic threat.
12:55You've done a great job of painting this landscape for us of all that we don't know.
13:00Just one more before we go. Over the next few days, what developments would point towards an ordinary
13:07case of pneumonia? What signs are you looking out for? What developments would raise, in the other
13:13direction, further questions for you? I don't think it can be an ordinary case of pneumonia, because they
13:19would have diagnosed that, and they would be saying that really quickly, that this was pneumococcal
13:23pneumonia, or influenza pneumonia, for example. But what I want to know is, what did they look for?
13:30What did they find? What didn't they find? What did they think it is? What tests are outstanding?
13:35All of that's going to be important. Then, are there any other cases? We know that there's about 200
13:41people that are under monitoring. Do any of them develop illness? Because they're acting as if this is
13:47communicable. That's why they're monitoring these contacts. You wouldn't monitor the contacts if it
13:52wasn't a communicable disease. So, are there going to be more cases? Then we have a different problem
13:57to deal with. Then we have an uncharacterized pathogen spreading from person to person.
14:04That's something that will raise the alarms. Amish, it's been a pleasure to tap your knowledge of
14:10emerging infectious diseases in biosecurity. Dr. Amish Adalja, a senior scholar at the Johns Hopkins
14:16Center for Health Security. Thank you ever so much for your time.
14:20Thanks for having me.