Will it become an epidemic? Can it be contained?
Those questions are on many minds for several reasons. Scientists know relatively little about MERS. We don’t yet know how to treat it. It’s related to other deadly respiratory ailments like SARS. Many wonder whether global institutions like the World Health Organization can keep people safe — especially after WHO’s failures in responding to Ebola.
But the situation does not appear quite as dire with MERS. Thanks to the lessons learned from previous outbreaks of respiratory diseases and relatively pro-active responses, the global health governance system’s response has reassured a number of experts that a full-blown MERS epidemic is unlikely. At the same time, MERS shows that there are still important shortcomings in global health governance.
1. There’s a lot we don’t know about MERS yet, but it doesn’t act like a disease that will become a widespread epidemic.
MERS appears unlikely to become widespread, in part because of its unique qualities. MERS is a relatively new disease. It was first identified in 2012 in Saudi Arabia, after a 60-year-old man entered a hospital in Jeddah complaining of shortness of breath, a week-long cough, and kidney failure. Between its discovery in 2012 and this past March, MERS had infected slightly more than 1,000 people and caused nearly 400 deaths.
Two facts about how MERS spreads make a widespread outbreak less likely. First, MERS doesn’t spread very easily. The average MERS patient causes only 0.7 additional illnesses. By contrast, the average SARS patient infected 5 other people. Many of the Saudi cases still occur in people who are in close contact with camels. Since the typical MERS patient does not infect another person, the disease can be contained.
Second, human-to-human MERS transmission is happening mainly within health-care facilities and among people with weakened immune systems. As a result, relatively simple changes in hospital procedures may stop MERS’ spread.
2. The South Korean government is trying to avoid China’s mistakes with SARS.
When SARS appeared in 2002, the Chinese government’s initial response was abysmal. It denied the reports of a new disease. It recommended ineffective prevention strategies, like using vinegar to disinfect the air. It imposed a news blackout to prevent reporting about “atypical pneumonia.” It prevented WHO officials from having access to hospitals and clinics.
These responses exacerbated the problem, giving the disease time to infect more people and causing people to question the government’s trustworthiness. The secrecy and failure to share information with international partners impeded a timely response, and China was widely condemned.
At first, the Korean government underestimated the disease’s extent and provided little information about how widely it had spread. This caused many to openly question the government’s ability to handle the crisis. By last Sunday, though, Seoul had thoroughly changed its tactics. The government is sharing the names of all the hospitals treating MERS patients, providing public information about how people can protect themselves, and actively countering rumors. President Park Geun-hye even postponed her planned trip to Washington this week so that she could help coordinate her government’s response.
The Korean government’s strategic shift shows that it understands the importance of sharing information to combat a disease outbreak — and the importance of responding to public unrest. But we have not yet seen whether this newfound openness will restore the public’s faith in the government’s ability to deal with public health, or whether the initial delay in responding will have long-term consequences.
3. Diseases like MERS move with people, but that does not mean that people should not move.
Travel spreads infectious diseases. In 1918 and 1919, a global influenza pandemic killed at least 30 million people worldwide, in no small part because World War I troop movements spread influenza around the globe. Nearly a century later, a never-before seen disease called severe acute respiratory syndrome (SARS) emerged in southern China.
Over nine months, SARS spread to 34 countries, caused nearly 8100 illnesses, and killed 774 people. After the outbreak ended, epidemiologists identified globalization and rapid travel as key to SARS’ rapid spread. Indeed, they traced roughly 4000 cases and 550 deaths to a single doctor who checked into a Hong Kong hotel in February 2003.
The current MERS outbreak in South Korea has been traced back to a 68-year-old man who had spent time in Saudi Arabia and United Arab Emirates.
When these sorts of outbreaks occur, there is often an impulse to close borders, restrict travel, and close down public gathering spots like schools and theaters. Indeed, nearly 2500 South Korean schools have been closed so far. Arrivals at South Korean airports, movie ticket sales, and amusement park admissions are down substantially.
But these reactions, while understandable, are ineffective and may cause bigger problems.
WHO is not recommending any travel restrictions, and a WHO-Korean government task force is urging schools to reopen. Why? Since MERS does not spread easily from one person to another, travel restrictions and school closings will do little to stop its spread. Rather, they may generate panic, which can have larger social, economic, and political consequences. They may also discourage people from seeking treatment.
The better strategies are contact tracing and monitoring those who have recently been in affected regions, strategies far more focused on key individuals than immobilizing the whole population.
4. MERS in South Korea should not distract us from what is happening in Saudi Arabia.
While the MERS cases in South Korea have received much attention in recent weeks, the disease remains largely centered in Saudi Arabia. MERS first emerged there, and more than 85 percent of human cases of the disease have happened in the country. Because there is so much we still do not know about MERS and because Saudi Arabia figures so prominently in its origin and transmission, this is where global health institutions need to devote a great deal of time and attention.
Unfortunately, the Saudi government has not shown much inclination to share information or to cooperate with the international community.
In 2013, WHO Director-General Margaret Chan lambasted the Saudi government for failing to share virus samples with WHO-affiliated labs, delaying the ability of scientists to research the virus and attempt to discover treatments. International officials have said that the Saudi government has repeatedly denied offers of help and assistance since 2012.
More recently, the Saudi deputy minister of health deflected attention away from MERS and suggested that the only reason for the high number of cases in his country was that it was looking for them. “The more you look, the more you find,” he told science journalist Helen Branswell.
If we have learned anything from the history of successful interventions by global health institutions, it’s that cooperation between national governments and international public health institutions is vital.
5. So far, WHO is doing its job.
Under the International Health Regulations, human cases of new diseases that have a high likelihood of spreading internationally should be reported to WHO. In response, WHO works to keep countries informed about risks, builds capacity to detect new cases, and coordinates an international response.
With Ebola, WHO largely failed to perform these tasks. In the case of MERS, though, it appears to be fulfilling its obligations.
WHO set up an emergency committee to work on MERS in 2013, and it publicly makes available both the minutes of its meetings and the names of its members. It has provided governments with guidance about proper procedures and policies for dealing with MERS, and it provides regular updates on the numbers of cases and epidemiological information.
What explains the difference? Part of it may be that WHO has experience working with this sort of virus. WHO’s response to SARS was widely praised, and MERS and SARS are in the same virological family. It may be that the organization has been monitoring MERS for a number of years, giving it time to develop its expertise and appropriate strategies.
Part of the difference may also be that, unlike Ebola, MERS has not strained the organization’s resources. So far, WHO has not asked the international community for financial contributions for MERS, suggesting that its current resources are enough to handle the outbreak. If things become more serious, WHO may need a serious infusion of money and personnel.
Furthermore, if MERS spreads to more countries, it could strain the ability of disease surveillance systems to monitor and trace new cases. The lack of funds to support and strengthen disease surveillance systems is a serious shortcoming in the international community’s efforts to stop the spread of infectious diseases.
Jeremy Youde is an associate professor of political science and department head at the University of Minnesota Duluth. His most recent books are The Politics of Surveillance and Response to Disease Outbreaks (co-edited with Sara E. Davies) and The Routledge Handbook of Global Health Security (co-edited with Simon Rushton). Follow him on Twitter @jeremyyoude.