Limits on use of samples said to delay MERS-CoV efforts

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May 23, 2013 (CIDRAP News) – World Health Organization (WHO) officials and others at the World Health Assembly (WHA) complained today that restrictions on the use of virus samples are delaying the investigation of Middle East respiratory syndrome coronavirus (MERS-CoV), according to news service reports.

WHO officials said the problem has to do with restrictions imposed by Erasmus Medical Center in the Netherlands, where the virus was first analyzed and identified as a new species last year, according to the Associated Press (AP). But the scientist who led that research denied any restrictions on use of the virus for research and public health purposes, the AP reported.

In a statement today, the WHO said the global MERS-CoV count has reached 44 cases with 22 deaths, following the fatal case reported in Saudi Arabia yesterday.

The WHO said the victim was a 63-year-old man with an underlying medical condition, which fits the profile of many of the other patients. He was hospitalized with acute respiratory distress on May 15 and died 5 days later, the statement said. The case occurred in Qassim, a province in central Saudi Arabia.

Saudi Arabia reported the fatal case yesterday but gave no details on the patient, other than to say he was a "non-Saudi." A Gulf News report today said the case raised the MERS-CoV death toll in Saudi Arabia to 17.

The WHO statement gave no information on how the latest victim might have been exposed to the virus.

At the WHA, Keiji Fukuda, MD, the WHO's assistant director-general for health security, said the agency is "struggling with diagnostics" for MERS-CoV because of a dispute over ownership of samples, according to the AP.

Others at the meeting then complained about the public health and legal consequences of how the virus was first handled and identified, the story said. Last summer Ali M. Zaki, MD, PhD, a physician then working in Jeddah, Saudi Arabia, mailed a sample from a patient to virologist Ron Fouchier, PhD, at Erasmus, who led the effort to identify the virus.

Others who want to obtain samples of the virus from Erasmus must sign a material transfer agreement (MTA) that deals with ownership and user rights, the AP story noted. Officials at the meeting said that has delayed some research, including development of serologic tests, the AP reported.

It was reported earlier this week that Canada obtained samples from Erasmus for public health research, but that the MTA barred the national microbiology laboratory from sending samples to other labs in the country.

WHO Director-General Margaret Chan, MD, MPH, "railed against the arrangement" at today's meeting, which surprised some of the audience, the AP reported. Chan urged health officials there to "share your specimens with WHO collaborating centers, not in a bilateral manner."

"Please, I'm very strong on this point, and I want you to excuse me," she reportedly said. "Tell your scientists in your country, because you're the boss. You're the national authority. Why would your scientists send specimens out to other laboratories on a bilateral manner and allow other people to take intellectual property rights on a new disease?"

But Fouchier told the AP that the MTA for the virus is like others used in the WHO's networks. He said there are no restrictions on use of the virus for research and public health purposes, only for "commercial exploitation and forwarding virus to third parties." He said those are common in all MTAs, including those used by the WHO.

Further, Fouchier said that once the virus was identified, diagnostic tests were developed in collaboration with several public health labs and were provided free to anyone who asked for them. "We have not denied access to the virus to any research and public health laboratory with the appropriate facilities to handle this virus safely," he told the AP.

Ziad A. Memish, MD, Saudi Arabia's deputy minister for public health, was also among those who complained at the meeting about restrictions on use of virus samples, according to a Reuters story. He said the virus was sent to Erasmus without permission and asserted that the "patenting" of the research processes that the Erasmus scientists used delayed the development of diagnostic and serologic tests.

When Fukuda was asked if he thought Erasmus had acted wrongly, he declined to answer directly, saying the WHO is focused now on responding to the disease, according to Reuters.

In slides that were presented at the meeting and posted online, WHO officials said they are planning "joint missions" with Saudi Arabia and Tunisia to investigate MERS-CoV, similar to a recent visit to China to investigate the H7N9 influenza outbreak.

According to the WHO presentation, critical gaps in science's knowledge of the virus include its geographic extent, the most important exposures that lead to infection, the degree of human transmissibility, and whether there are human "super spreaders." "Super spreaders" played a part in spreading the SARS (severe acute respiratory syndrome) coronavirus in 2003.

See also:

May 23 AP story

May 23 WHO statement

May 23 Gulf News story

May 23 Reuters story

WHO slide presentation

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