Surprised by MERS Again? The Middle East Respiratory Syndrome Coronavirus in Asia

It's hard to believe but I first posted the article that this is adapted from almost two years ago to the day. Little has changed other than Ebola drawing the world's attention away from MERS until a new and significant outbreak erupted in east Asia three weeks ago after being introduced by a traveler returning from the Middle-East.

Possibly the most interesting aspect of the emergence of this new disease killing people in the Middle East, others who have traveled there and recently spreading in Korea, is that so many people are surprised. Expressions of angst from the international health community are understandable. The last time a novel coronavirus similar to this one (SARS) jumped into people and spread around the world, thousands were sickened, hundreds died, and billions of dollars of economic losses in trade and travel were incurred in a matter of months.

Over the ensuing years, funding and emphasis on these emerging disease issues has fallen by the wayside. That changed briefly a couple of years ago, when the director general of the World Health Organization moved the Middle East Respiratory Syndrome, or MERS coronavirus, to the top of her concerns list, calling it a "threat to the entire world." If we only focus public health on the issues of obesity, heart disease and cancer during the periods between outbreaks, and ignore the fact that roughly a billion people are infected with some type of zoonotic disease every year, not to mention that five or so new infectious diseases emerge annually, then yes, being surprised and unprepared is completely understandable.

Caught off-guard then and again by Ebola and then yet again by MERS in Asia, predictable arguments unfold among a myriad of stakeholders and pundits: Who is in charge? Is there enough being done? Why wasn't this prevented or controlled earlier? Who should have been told what and how soon? And of course, from where and why did MERS or Ebola emerge?

While both politics and human relations confound answers to these questions, science can already help to remove some of the mystery for the latter one. The same approach that we have used to tell us how many new diseases we can expect to appear each year lets us understand a great deal about what facilitates their emergence, where they hide before they begin spreading in people, and where in the world do the greatest risks exist. We can determine a probability or a risk value for people moving these diseases to different cities or countries around the world as we did with Ebola.

Being surprised or ill-prepared is no longer acceptable and we no longer need to wait until human-to-human transmission of these diseases in a hospital setting sends everyone into panic. Based on real facts from the last 50 years, I can tell you that there is a greater than 70 percent probability that the MERS coronavirus originated at some point in time from wildlife and we know now that the virus is common in dromedary camels in one part of the world. All known evidence points to the first human cases that begin the chains of death in Ebola outbreaks arise from contact with infected wild animals. Not only does this knowledge help us prevent outbreaks, is also demonstrates that human health experts cannot be expected to work alone to understand or prevent these diseases, expertise from animal health and ecology is essential.

Equally important, we know the majority of these diseases arise during one of three human activities -- change in land use, changes in agricultural practices, or changes in food industry practices. We know that most of these diseases arise in less-developed countries, places where wildlife comes into increasing contact with growing populations. At the same time, dramatic changes are taking place in how land is used and food is produced. All of these are predictable, observable, and can include processes to reduce risk. We also have learned each of these activities is characterized by certain routes of transmission such as direct contact, insect spread, contamination, etc., so the good news is that we already have many of the tools we need to prevent even the most novel disease.

As with earthquakes, we can do much to reduce the chances of people being hurt by emerging infectious diseases. We know where new diseases are most likely to occur. We need to invest more effort in developing countries, especially those that are rapidly changing. The U.S. Agency for International Development (USAID) began doing this with its Emerging Pandemic Threats Program, but government, and certainly not just one government, cannot do it alone. Surveillance systems need to include wildlife and environmental monitoring if we want to prevent diseases upstream rather than cleaning up rubble in the aftermath. Of course we will have to feed more people every year, but as countries rush to increase agricultural production, ensuring best practices could reduce disease emergence just as proper engineering and construction practices reduce the death toll resulting from earthquakes.

In this realm, the private sector could help lead us to a healthier future. They are the major actors in modern agriculture and the extractive industries such as mining, forestry, and energy exploration.

Prevention and early warning systems, whether for storms, traffic jams, or global health are dependent on collaboration and steady investment rather than reactionary funding. Being surprised by MERS or Ebola or the next flu strain that arrives in the US is not only surprising, it's a clear symptom that we are not doing enough.