Is the World Facing the Next Pandemic?

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.”

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