Triumphs, trials, and tribulations of the global response to MERS coronavirus
2014; Elsevier BV; Volume: 2; Issue: 6 Linguagem: Inglês
10.1016/s2213-2600(14)70102-x
ISSN2213-2619
AutoresScott J.N. McNabb, Affan Shaikh, Jennifer B. Nuzzo, Alimuddin Zumla, Dominique Heymann,
Tópico(s)COVID-19 and Mental Health
Resumo22 months after its discovery, and despite extensive investigation and research, the source and origin of the Middle East Respiratory (MERS) coronavirus remain unknown.1PLoS CurrentsPLoS PathogensState of knowledge on MERS-CoV. PLoS Speaking of Medicine, 2014.http://blogs.plos.org/speakingofmedicine/2014/01/17/state-knowledge-mers-cov/Google Scholar As of April 26, 2014, 261 laboratory-confirmed cases of MERS coronavirus infection have been reported, including 93 deaths.2WHOMERS-CoV summary updates.http://www.who.int/csr/disease/coronavirus_infections/archive_updates/en/Google Scholar Although sustained human-to-human transmission has not been reported,1PLoS CurrentsPLoS PathogensState of knowledge on MERS-CoV. PLoS Speaking of Medicine, 2014.http://blogs.plos.org/speakingofmedicine/2014/01/17/state-knowledge-mers-cov/Google Scholar a global concern remains that the virus could become more contagious and deadly. An overabundance of caution is certainly prudent, but with the latest discovery—that the virus was documented in dromedary camels as long ago as 19923Alagaili AN Briese T Mishra N et al.Middle East Respiratory Syndrome coronavirus infection in dromedary camels in Saudi Arabia.mBio. 2014; 5 (e00814): e00884Crossref Scopus (30) Google Scholar—interpretation of the epidemiology has become more difficult. Are the recently identified cases in Jordan, Qatar, the United Arab Emirates, and Saudi Arabia new, or a part of a long series of human disease? Improved collaboration between clinicians, scientists, and public health authorities will be necessary to understand the epidemiology and define the sources and modes of transmission. Lessons from the SARS coronavirus outbreak4Institute of Medicine (US) Foum on Microbial Threats Knobler S Mahmoud A Lemon S Learning from SARS: preparing for the next disease outbreak—workshop summary. National Academies Press, Washington, DC2004Google Scholar in 2003 and the influenza H1N1 pandemic5Del Rio C Hernandez-Avila M Lessons from previous influenza pandemics and from the Mexican response to the current influenza pandemic.Arch Med Res. 2009; 40: 677-680Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar in 2009 suggest that effective, collaborative public health research in support of outbreak investigation and comprehensive risk management is encouraged by mutual respect—for others, authority, governance, information, and property (both intellectual and physical)—and a solid agreement. But the meaningful collaboration that helped the scientific community to rapidly identify the SARS coronavirus has not been seen recently. Collaborative research into MERS coronavirus has been scarce, with investigations marked by bitter disagreements between public health authorities and scientists about the virus' discovery and the ensuing publications, processes, and patenting of products.6Butler D Tensions linger over discovery of coronavirus.Nature News. Jan 14, 2013; (accessed April 5, 2014).http://www.nature.com/news/tensions-linger-over-discovery-of-coronavirus-1.12108Google Scholar The recent disagreements played out in the media raise several issues that should be addressed. Key among them is the absence of a consensus-built governance agreement for public health investigation and research when an event is recognised as a global public health emergency. Such an agreement would include the controversial issues of how to share animal and human specimens, investigational products (eg, pathogens and viral isolates), and intellectual property (eg, public health surveillance data and scientific publications). Without agreement about the mutually beneficial roles, responsibilities, and legitimate contributions of clinicians, scientists, and public health authorities, parties end up either encroaching on one another or not communicating—both of which are happening now with respect to MERS coronavirus. Public health authorities and academic scientists must work together to discover and pursue investigation of emerging or re-emerging infectious diseases, and clinicians and scientists must fulfil their legal responsibility to report relevant data to public health authorities through official mechanisms. Such reporting enables public health authorities to undertake their legitimate and crucial role in investigating, preventing, and controlling future transmission. Successful examples of this delicate yet important balance include the recognition, reporting, and research around Legionnaires' disease7Fraser DW Tsai TR Orenstein W et al.Legionnaires' disease: description of an epidemic of pneumonia.N Engl J Med. 1977; 297: 1189-1197Crossref PubMed Scopus (1344) Google Scholar and Lyme disease8Steere AC Malawista SE Snydman DR et al.Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities.Arthritis Rheum. 1977; 20: 7-17Crossref PubMed Scopus (980) Google Scholar—outbreaks that were reported appropriately, while public health research ensued. Four considerations are pertinent to an agreement: the immediate need to control the spread of disease by public health authorities; the intellectual curiosity of clinicians and scientists; the long-term commercial interests of the pharmaceutical industry; and the economic wellbeing of the farming and ranching communities. Governance should be built around One Health, an interdisciplinary collaboration between human and veterinarian medicine and health, because economic loss is an important consideration (as can be seen from the negative economic effect of the present influenza H7N9 outbreak9Minggao Shen BW China equity strategy—avian flu H7N9 remains a risk. CITI Research, Beijing2013Google Scholar). Additional steps should be taken to protect the economic interests of farmers and livestock owners. Livestock insurance schemes, already used for protection against drought, could be used for reimbursement.10Economist.com. Livestock insurance in Kenya: no risk, no reward. Economist.com, 2014.http://www.economist.com/blogs/baobab/2014/04/livestock-insurance-kenyaGoogle Scholar The development of a global biological risk management fund to share the burden of economic loss would enhance the mission of the 2005 International Health Regulations (IHRs). The sovereign rights of IHR state parties must be respected. National ministries of health are responsible for the detection, assessment, reporting, and response to public health issues that threaten their populations. The willingness of states to collaborate on comprehensive risk assessments is dependent on the perception that doing so will not conflict with their own national self-interest; the global scientific community cannot force a country to collaborate. Unfortunately, the IHRs offer no guidance for how to collaborate in this way. Strengthened global collaboration in public health research requires trust. And trust can only be built through the transparency embodied in clearly defined norms that govern how research products and data will be used and who owns them. Although the IHRs require states to share timely and accurate reports about public health emergencies of international concern, they do not specify in any practical detail other important features of data sharing and public health research collaboration, including ownership and access to patient specimens, research data, and scientific products (eg, diagnostics, vaccines, and medical countermeasures). The pandemic influenza preparedness framework11WHOPandemic influenza preparedness framework for the sharing of influenza viruses and access to vaccines and other benefits. World Health Organization, Geneva2011http://whqlibdoc.who.int/publications/2011/9789241503082_eng.pdf?ua=1Google Scholar is a commendable start, but is limited in scope and does not provide guidance for data sharing for non-influenza viruses or other biological specimens. Recent discussions within the Convention on Biological Diversity in Nagoya, Japan,12Convention on Biological DiversityThe Nagoya Protocol on Access and Benefit-sharing.https://www.cbd.int/abs/Google Scholar are also a step forward with respect to the ownership of biological materials. What is now required is for the public health and research communities to rally around the design and adoption of a consensus-built global governance agreement for rapid, effective collaborative investigation in the event of emerging infectious disease threats with pandemic potential. This process could occur through the amendment of the existing IHRs, with the addition of clear codes of practice for the sharing of public health surveillance data and other intellectual property and for the conduct of the collaborative epidemiological research necessary for comprehensive risk assessment. Enhancement of the IHRs in this way would clearly define international expectations about how essential public health data and products that emerge should be managed, shared, and owned. Likewise, it would clarify how states should interact when crucial information for risk assessment is needed by the global health security community. Such a development would improve the state of global health security. We declare that we have no competing interests. Political commitment to MERS-CoV in Saudi ArabiaOn April 27, Saudi Arabia reported 16 new cases of infection by the Middle East respiratory syndrome coronavirus (MERS-CoV). Worldwide, from September, 2012, to April 26, 2014, WHO has reported 261 laboratory-confirmed infections, including 93 deaths. According to Nick Phin of Public Health England, and academics involved in the Global Centre for Mass Gatherings Medicine, the recent apparent rise in MERS-CoV infections in Saudi Arabia could have resulted from various factors, including seasonality, increased proactive screening, and poor infection control measures. Full-Text PDF
Referência(s)