Spotlight: Health 2014

Can Lessons from SARS Cure MERS?

Global health security is only as strong as the world’s weakest link.

An electron microscope image of MERS; the virus particles are depicted in yellow. (Mark Williams / Flickr)

In 2003, severe acute respiratory syndrome (SARS) emerged seemingly without warning, causing disease in many parts of the world and costing affected countries over $30 billion. Over 8,000 individuals were infected; of those, 774 died.

2012 marked the first reported outbreak of a new respiratory disease, Middle East respiratory syndrome (MERS). Initially contained to the Arabian Peninsula, it has now spread to the United States as well. As of June 11, 2014, 699 lab-confirmed cases of the Middle East respiratory syndrome (MERS) have resulted in 209 deaths in 21 countries.

This morning during the Aspen Ideas Festival's Spotlight: Health program, a panel called “Global Disease Threats: What’s Coming and Can We Stop It?” compared the two diseases and their respective treatments. The group included Tony Fauci, Director of National Institute of Allergy and Infectious Diseases at the National Institutes of Health; Yu Wang, Director General at the Chinese Center for Disease Control and Prevention; Tom Frieden, Director of the Centers for Disease Control and Prevention; and Richard Besser, Chief Health and Medical Editor at ABC News.

Below, six lessons learned from SARS which these experts say might mitigate the next (inevitable) epidemic’s spread:

1. We did not eliminate SARS. The NIH developed a vaccine for SARS that it never deployed.

Tony Fauci: We got lucky, but we did some fundamental low-tech classic 19th to 20th century public health measures of identification, isolation, quarantine. We didn’t implement or use a vaccine. There was no treatment for it. It was just good public health measures.

We learned a reconfirmation that epidemics happen. It’s an inevitability that there are emerging and reemerging infections. The other thing we learned is that we must have transparency because there was a window early on when SARS broke out in China and it was only when it got to Hong Kong and the people went out from Hong Kong that it spread. There was a gap of a period of time when there was some denial--maybe it was influenza…. One final thing that we showed is that with the new technologies of extremely rapid sequencing and identification of a microbe [treatments can be developed quickly]. We actually had a vaccine for SARS that we never had to deploy…. As we were ready to go to implement it, the epidemic disappeared.

2. Our national public health is only as secure as the weakest link in the global chain.

Tom Frieden: SARS was a tipping point. SARS really led to the revision of the international health regulations a couple years later. It led to the recognition that we’re all connected, and we’re all dependent on the weakest link in the global chain. That was critical in identifying what are the things that need to be present all over the world, so each country can be safer and the world can be safer. Those three main domains are finding things, or detection; stopping things, or response; and preventing things.

3. Because of SARS, China was better prepared for H7N9.

Tom Frieden: You couldn’t have a more different response [than to SARS]. [China] did everything right in H7N9: they immediately identified it, they responded appropriately, they were completely transparent. They posted the genome to a global sharing system within hours of finding it.

The first tipping point was about the recognition of the importance of strengthening detection, response, and prevention all over the world. The second was the recognition that, in order to do that, you have to build national capacities. You can’t just swoop in and come out -- you have to make sure that the country has day-to-day systems that can work and be scaled up.

4. MERS is spreading -- but not in Aspen.

Tony Fauci: It would not surprise me at all if someone came into the Aspen Ideas Festival who was at the Middle East and actually had MERS. The likelihood that that person would spread it to us in this room is extraordinarily unlikely because it doesn’t spread from person to person.

It is quite clear now two years [after the outbreak] that there are couple things that could have been done better. Unquestionably, hospital infection control policies were not optimal. Because if done properly, there should not have been the spread among hospital personnel who were taking care of the MERS patients.

The other thing that likely could have been done better is the kind of case control contact traces, so that when someone gets infected you really aggressively -- like the CDC does in the United States -- immediately go and find out was there subclinical spread and what is the extent of the spread. It is very important to understand the capability of the virus.

5. SARS made the Chinese government more transparent, and transparency is good.

Yu Wang: In the last ten years the world is changing. Information transparency is of course very, very important for infectious disease, public health, and emergency events. Just after SARS, the WHO launched international health regulations to make [clear] the key lessons learned from SARS. Then H7N9 occurred in China.

From SARS, gradually step-by-step Chinese society and government little-by-little changed their manner to deal with information.... Before, the government and policymakers were thinking how to make societies more stable. It was useful to keep information... without releasing... the information. But now they understand: if we are more early to give the clear, definite information to the public, this is much better to make the society and economy more stable.

6. Judging by government's inaction, we still haven’t learned from SARS.

Tom Frieden: The bigger lesson [from MERS] is the need to have national capacities, and that’s what the work we’ve started with global health security is all about. Each country should have an emergency operations center that can swing into action in 120 minutes. Each country should have the ability to diagnose dangerous conditions around the country. Each country should have epidemiologists, like the CDC’s disease detectives, who can investigate situations and respond to them.… The international health regulations were passed in 2005. The deadline was 2012 to comply with them and only 16% of countries even claim to have complied.