Is the World Facing the Next Pandemic?
A new deadly respiratory disease out of the Middle East is making the World Health Organization plenty nervous.
GENEVA—Dr. Margaret Chan, Director-General of the World Health
Organization, is a slight, Chinese woman prone to power shades of
lipstick. At the World Health Assembly in Geneva, where ministers of
health from the U.N.’s 194 member countries gathered to discuss the
world’s most pressing illnesses, Chan’s lip-color ranged from a light
rose to fire-engine red, but her attitude never swayed.
As Hong Kong’s Director of Health during the 2003 bird flu outbreak,
Chan became known for both her wry humor and whip-sharp demeanor. In the
middle of that epidemic, she told
the press, “I eat chicken every day, don’t panic everyone.” Outside,
reluctant local officials were killing over 1.5 million chickens at her
behest. At the World Health Assembly, held from May 20 to 28th, she
introduced various ministers as “my brother,” and “my sister,” drawing
both laughter and applause from the buttoned-down attendees.
But Chan’s epidemic persona made a repeat performance at this year’s
assembly as a recent outbreak of a new threatening virus was discussed.
The coronavirus, which only recently gained the dubious honor of its
very own terrifying acronym—the Middle Eastern Respiratory Syndrome
(MERS)—is a member of a large family of viruses, cousin to both SARS and
the common cold. The first known case was found last September in
Qatar, as the summer’s heat broke. A 49 year-old man arrived at a
doctor’s office in Doha, complaining of mysterious respiratory problems.
From there, things moved quickly.
Four days later, he was admitted to an intensive care unit, and
within less then a week he was medevac’d to the United Kingdom. Doctors
in England sent samples off to the Health Protection Agency, and it
wasn’t long before the World Health Organization (WHO) officially
announced the discovery of the new strain.
MERS is less contagious than its Asian cousin SARS,—which killed over
8,000 people in the early 2000s—but is far more lethal. To date, there
have been 58 other lab-confirmed cases, 33 of whom have died. Most of
the patients were male, older, wealthy, and had recently spent time in
Saudi Arabia. MERS may be spread from person to person; although the
exact means of transmission is still unknown, family members and health
care workers around the sick have also contracted the disease.
Fourteen months later, we don’t know much more about its
epidemiology. Comparatively, the H7N9 outbreak in China this spring was
identified in less then three days, and the epidemic considered
controlled in a few weeks, a response that has since been lauded. A
recent report
by the European Centre for Disease Control and Prevention marveled at
the "unusual … degree of uncertainty at this stage” in the coronavirus’
discovery, and Chan has taken it on as her new cause célèbre. “The
current situation demands collaboration and cooperation from the entire
world,” she said. “A threat in one region can quickly become a threat to
all.”
The slow-moving international response is equally complicated. Ali
Mohamed Zaki, the Saudi Arabian doctor who treated what was
retrospectively determined to be the first MERS case (a 60 year-old man
in Saudi Arabia, who actually died in the spring of 2012, months before
the disease was discovered) didn’t at first know he was dealing with a
new virus. Zaki sent a sample from his patient to virologists at Erasmus
University Medical Centre in the Netherlands, where Albert Osterhaus
and Ron Fouchier identified MERS. The Dutch scientists have since filed a
patent on the virus, adding a layer of intellectual property rights to
the riddled regulations of international health policy. As it stands,
Erasmus used their patent to sign contracts with vaccine companies,
meaning the companies have to approve every use of the virus.
At the World Health Assembly, Saudi Deputy Health Minister, Ziad
Memish, explained that the sample shouldn’t have been sent to Erasmus in
the first place, and said the doctor who’d done so had been dismissed.
If the sample was delivered to a WHO-certified lab, where patents are
not allowed, intellectual property rights would not have become an
issue. Memish said it’s this process that’s slowing the development of a
diagnostic test; for their part, the Dutch scientists told Bloomberg that
they’ve shared the virus with over 40 labs worldwide, and that
submitting a patent was simply standard scientific protocol. As China
knows well after being rebuked for their insular handling of H1N1, the
international community does not look fondly on protectionist policies
when it comes to potential pandemics.
The only laws viruses answer to are Darwinian—the infectious agents
evolve useful adaptions through trial and error, often going through
drastic transformations as they adapt to new hosts—and without blood
tests, it’s impossible to know for sure how many people have already
been infected with MERS. It’s quite possible it’s much more widespread
then it appears, with many mild cases going undiagnosed. As Keiji
Fukuda, WHO’s assistant director-general for health, said, “The thing
that going forward makes my stomach feel upset is that we don’t know
what kinds of characteristics it’ll gain.” The urgency to move on both a
vaccine and anti-retroviral treatment sharpens as the year slopes
toward the hajj, peaking in October, when millions of pilgrims will stream into the area.
Chan told the Assembly she’d be looking into the matter, telling the
plenary, “Please, I’m very strong on this. Making deals between
scientists because they want to take out [intellectual property] and be
the first to publish in scientific journals, we cannot allow that.” She
continued to resounding applause, “No intellectual property should stand
in the way of you protecting your people.”
The specter of SARS, the last major potential global threat, didn’t
materialize as anticipated, and it’s difficult to weight comparative
risk with epidemiologists whose job it is to speak in worst-case
scenarios. Not since the Spanish influenza has there been a global
pandemic, and it’s unlikely—but entirely possible—the coronavirus may be
the next. WHO recommends that any travellers returning from the Middle
East who develop respiratory symptoms should be tested for MERS, and
urges countries to promptly report potential cases. But WHO lacks any
regulatory teeth, and as the contrast between Saudi Arabia and China
this spring demonstrated, countries’ transparency is ultimately
self-regulated.
As Chan said, "Any new disease is full of uncertainty," and this one
still has more unanswered questions than most. Last week, two new cases
were confirmed in Italy, without any public progress in the discerning
the disease vector. “Going forward,” Chan said, “we must maintain a high
level of vigilance.”
http://prospect.org/article/world-facing-next-pandemic