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Saudi Arabia feels the heat over Mers
May 24, 2014, 12:25 pm
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A couple of Muslim pilgrims cover their faces to prevent infection from respiratory virus known as the Middle East respiratory syndrome (MERS) in the holy city of Mecca, Saudi Arabia.

Scientists allege culture of suspicion and stubbornness stymied efforts to curb spread of virus

In a north London laboratory on a Saturday in September 2012, an e-mail arrived from a team of virologists in the Netherlands that spooked even some of the world’s most seasoned virus handlers.

It contained details of a mysterious viral pathogen that had been found in two patients — a Qatari in intensive care in Britain, and a Saudi who died in a Jeddah hospital of pneumonia and renal failure.

This information-sharing between world-leading specialists proved fruitful: Within days the new virus had been identified as one never seen before in humans, had some of its genes sequenced, and its genetic ancestry published online for scientists around the world to see.

Yet that international collaboration was not to last.

Instead, western scientists allege, the cooperation gave way to a Saudi culture of suspicion and stubbornness that has allowed the Middle East Respiratory Syndrome (Mers) virus, as it has become known, to kill more than 175 people in Saudi Arabia, spread throughout the region and reach as far as Malaysia, Greece, Lebanon and — via Britain — the US.

The disease, like its cousin, Severe Acute Respiratory Syndrome (Sars), causes coughing, fever and sometimes fatal pneumonia. More than 650 people worldwide have been infected with it, and Mers is reaching new victims every day in the kingdom, killing around 30 per cent of them.

Experts say these infections and deaths could have been stopped well within the two years since Mers first emerged — and would have been if Saudi authorities had been more open to outside help offered by specialist teams around the world with the technology, know-how and will to conduct vital scientific studies.

But according to scientists involved in tracking Mers over the past two years, the Saudis have rejected repeated offers of help, including from World Health Organisation (WHO) experts, as well as the Dutch specialists at the Erasmus Medical Centre in Rotterdam and the London team working for Public Health England (PHE).

In Saudi Arabia, no case-control study has been completed, meaning fundamental questions cannot be answered about the virus’ capabilities, where it came from, and what it might do next.

Saudi Deputy Health Minister Ziad Memish told Reuters he was “surprised” by such criticisms, describing work done by his Ministry of Health since the emergence of the disease as “nothing but collaborative”.

Defence

He pointed out that scientists still struggle to understand other deadly viruses decades after they were first identified, and questioned the motives of some critics.

“I’m happy” with the way the Saudi authorities have handled this virus outbreak, “and will continue to involve more partners to make knowing the details of the virus a global success,” he said in an e-mail.

Primary responsibility for the response lies with the Saudi Ministry of Health, which under international health regulations reports to the WHO on Mers cases.

The ministry has from the start worked intermittently with various global agencies and institutions, including the WHO, the US Centres for Disease Control and Prevention, the University of Columbia and Ecohealth Alliance.

Frustration

Some of them have expressed frustration about Saudi authorities’ apparent lack of urgency.

Saudi suspicions about working with teams of researchers outside the kingdom — and the deputy minister’s desire to stay in control — may have been prompted by precisely the information-sharing that characterised the virus’s first few days, interviews with key scientists and public health officials involved in tracking Mers since 2012 suggest. Memish did not respond to that suggestion.

Ab Osterhaus, who heads the virology department at the Erasmus Medical Centre in Rotterdam, said patenting the virus was the “normal thing to do” in such a situation, and said his lab freely shared details of the virus with everyone and anyone who wants to conduct research.

Patents

There are few patents on viruses, largely because most of them were discovered many years ago. But research institutes often take out patents, at the same time as sharing a virus freely, as a way of encouraging future interest from industry in developing vaccines or other drugs.

“We’ve always been very open with everything,” Osterhaus said. “Somebody should be doing the epidemiological work in Saudi Arabia, and we have all the techniques operational today to be involved in those kinds of studies, so we’d be happy to collaborate.

“We have offered our services to Memish, but apparently we are not the obvious candidates to help.”

Others who worked with Saudi scientists at the very beginning of the outbreak, when Mers had not even been named and was only just starting to be investigated, say Saudi authorities — and Memish in particular — wanted an increasing level of control.

As the frustration over the response emerges, big questions about the deadly virus remain.

Comparison

Memish defends his country’s actions and says he has collaborated widely. He points to other infectious viral diseases, such as Ebola, which has caused sporadic but deadly outbreaks in Africa since it was first identified 40 years ago and about which scientists still have limited knowledge.

“All these collaborations have answered many questions but of course [there] still remain some to be answered,” he said.

“Look at Ebola, which has been around for many years, and tell me ... do we have all the answers on source, mode of transmission from zoonotic source and treatment or vaccine prevention?”

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