As the world grapples with the growing threat posed by Middle Eastern respiratory syndrome (MERS), one critical issue has been largely ignored: the question of viral sovereignty. Simply put, who can lay claim to a virus? Who should own — and have the rights to profit from — a pathogen?
From the start, investigators’ efforts to thwart a MERS pandemic have unfolded alongside an unsavory battle to stake claim to the potential cash bonanza of investigating and finding treatment options. As a result, we face a growing risk that avarice will derail efforts to halt the spread of MERS, as scientists and governments divert energy from public health to legal wrangling.
These issues are gaining urgency with the approach of the hajj season, which begins June 28 with the start of the Muslim holy month of Ramadan. Over the next three months, some 12 million Muslim pilgrims from around the world — including an estimated 11,000 from the United States — are expected to travel to the sacred city of Mecca in western Saudi Arabia, 3 million of whom will perform hajj, a duty for all able-bodied Muslims who can afford the journey. This mass gathering greatly increases the potential for MERS to spread when the pilgrims return home. To date, 701 cases have been reported globally, with 249 lives lost to the virus since July 2012, according to the World Health Organization (WHO).
To appreciate the risk, we need look no further than the 2005 avian influenza outbreak in Indonesia. In 2007 then–Minister of Health Siti Fadilah Supari moved to halt sharing of the virus at the peak of the epidemic. She did so because third parties (including the Western biotechnology industry) were using samples without Indonesia’s consent and in violation of WHO guidelines, with private companies selling patented vaccines created from the donated samples at prices that Indonesians simply could not afford.
Predictably, Indonesia’s actions sparked intense criticism, with some leading Western experts attacking the very concept of viral sovereignty. But this critique was — and is —shortsighted, failing to take into account the realities of a world divided as never before between haves and have-nots. Moreover, subsequent events proved the wisdom of Supari’s tactics, as WHO stepped in to broker an agreement providing for more equitable terms for sharing and access.
At the heart of the unfolding MERS battle is the Netherland’s Erasmus Medical Center (EMC), a private laboratory notorious for its baldly acquisitive ethos. The virus was first reported in samples obtained from a Saudi patient who ultimately died in July 2012. As recounted by The Economist, an Egyptian physician sent the samples overseas to the EMC without notifying — let alone seeking permission from — Saudi health authorities. EMC investigators proceeded to isolate and sequence the virus. After determining it to be novel, they initiated efforts to patent it.
The EMC has raises the stakes by just making public an aggressive international patent application claiming the MERS virus as a whole, its genetic material, related diagnostics and its future use in vaccines and vaccine development. (This is precisely the course of action the EMC attempted to follow with SARS until WHO put a stop to it.)
The center’s behavior is in direct contravention of the 1992 Convention on Biological Diversity, to which both Saudi Arabia and the Netherlands are parties. The convention gives clear ownership of viral materials to their countries of origin and requires that country of origin give consent to sharing them with other parties and only under terms agreed on by both parties.
Two years after the first MERS outbreak, the commercial stakes continue to rise — and with them, the global health risks. To be sure, where viral sovereignty is at issue, there will be hard cases. In countries lacking intellectual or capital resources and with underdeveloped public health infrastructure, colonial commercialism may to some extent prove unavoidable, as poor countries are forced to depend on the technology and experience of wealthier nations.
That said, Saudi Arabia poses no such challenges — something I can attest to from experience. During my two years of practicing critical care medicine in the kingdom and my decade of academic collaboration on hajj medicine with the Saudi Arabian National Guard Health Affairs and the Ministry of Health, I know that Saudi Arabia possesses a first world health infrastructure, a burgeoning biotechnology industry and an enviable national health system.
In an age when a pandemic is just a plane ride away, our only hope of thwarting MERS — and other deadly diseases to come — is through cultivating a global culture of trust and collaboration. A first step in this direction would be to recognize Saudi Arabia’s viral sovereignty rights with regard to MERS, a disease that Saudi Arabia, more than any other nation, stands prepared to take the lead in eradicating.