By Filippa Lentzos, May 18, 2020
In the throes of the coronavirus pandemic, representatives to the World Health Organization’s (WHO) governing body will meet virtually this week for a regularly scheduled annual meeting. The European Union, Australia and other countries have called for the global body to investigate the origins of the pandemic and member countries will now have the chance to discuss the issue. While the opening of any investigation will be a politically fraught process, that the matter will come up at the World Health Assembly at all raises an important question, what would such an inquiry look like?
The WHO has been investigating aspects of the pandemic since January and has already sent two missions to China, where the first cases of COVID-19 were reported. These early site visits, interviews, and observations in China have laid important ground work for any future effort. Amid early uncertainties over whether the novel coronavirus was spreading among humans, the WHO conducted a field visit to Wuhan, then the outbreak’s epicenter. For two days beginning on January 21, officials focused on China’s public health response to the novel coronavirus, talking with relevant officials and visiting sites like the Wuhan Tianhe Airport and the Hubei provincial Center for Disease Control.
The next month, a WHO-China Joint Mission on the outbreak was conducted, one led by a senior advisor to the WHO director-general and the chief expert of the Chinese National Health Commission. The mission involved a team comprising 25 experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the United States, and the WHO, and it stretched over nine days beginning on February 16. Experts talked with a raft of people, including provincial governors, municipal mayors, senior scientists, public health workers, and others. They visited hospitals, disease control agencies, emergency supply warehouses, and even a wet market in Guangzhou, the sort of place many scientists believe the coronavirus could have jumped to humans.
The Joint Mission paid only limited attention to the potential origins of the pandemic, and its mission report merely noted that the novel coronavirus is a zoonotic virus, that bats appear to be the reservoir of it, and that no intermediate hosts have yet been identified. But one of the report’s conclusions was that “additional effort should be made to find the animal source, including the natural reservoir and any intermediate amplification host, to prevent any new epidemic foci or resurgence of similar epidemics.”
To that end, and in line with the prevailing theory that the spillover event happened at a wet market, the Joint Mission report highlighted activities already underway by Chinese authorities to investigate the pandemic’s origins. These involved taking environmental samples from the Huanan Wholesale Seafood Market in Wuhan, obtaining records about the wildlife species sold at the market, as well as examining early COVID-19 cases in Wuhan.
Wet markets, where animals are slaughtered, cut up and sold on the spot, provide ideal conditions for viruses to jump from one species to another, and it is a likely theory for where the spillover event happened. But there are also other potential spillover sites relevant to COVID-19 that have come to the political fore, and calls for an international investigation specifically on the pandemic’s origins are now mounting from global leaders. One of the earliest calls came from Australia, which said it would use its seat on the executive board of the World Health Assembly to push for a WHO-led investigation.
A sensible, but stop-gap approach. A World Health Assembly mandate would anchor an investigation in an existing international framework with established rules and procedures of operation. The World Health Assembly, as the world’s premier forum for dealing with public health, is an obvious choice, and while politicized, it is fairly science-driven, and certainly less politicized than other international forums like the UN General Assembly, the UN Human Rights Council, or the UN Security Council, where one country or another frequently blocks international action on a given issue seemingly as a matter of course. An investigation could potentially be mandated in a timely fashion, and funded through assessed contributions from the World Health Assembly’s 194 member states.
A public health-focused investigation is also the most politically feasible approach to get China on board, and cooperation from Beijing would be crucial for an investigation of this nature. While the WHO hasn’t formally supported an investigation into the pandemic’s origins, the Emergency Committee of independent scientific experts advising the organization’s director-general on the pandemic called earlier this month for identifying “the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts.” This makes sense, and echoes the earlier conclusion of the WHO-China Joint Mission. The aim of a potential investigation must be to find an answer to how the pandemic started, or at least to get to a point where the international community is satisfied there is enough clarity about the likely origin.
Such an investigation would be important to better understand the animal to human transmission aspects of coronaviruses, to prevent future outbreaks, to strengthen surveillance and preparedness, and to combat misinformation and disinformation campaigns confounding responses. The investigation must be undertaken in a cooperative spirit; it should not be about apportioning blame, or setting up future insurance claims.
A forensic investigation. Few specifics have been offered on the sort of investigation Australia and others would like to see, but if it is to be a genuine effort to query origins, answers cannot solely be drawn from virology, infectious disease genomics, genome science, and epidemiology. As one well-known molecular biologist and biosafety expert told the Washington Post, “Science is not going to shift this from a ‘could have been’ to a ‘probably was’.” Investigating the range of possible spillover sites–from the wet market, to an accidental lab or fieldwork infection, or an unnoticed lab leak–requires a forensic investigation.
Obtaining case histories, epidemiological data, and viral samples from different times and places, including the earliest possible samples from infected individuals and samples from wildlife, is paramount, but not sufficient. A forensic investigation would additionally involve auditing and sampling viral collections at relevant labs that had been studying coronaviruses, examining the types of experiments carried out and the viruses used, and reviewing the safety and security practices in place.
Key data would also come from documents, including standard operating procedures at the labs and during fieldwork, risk assessments of individual experiments, experiment logs and fieldwork notebooks, training records, waste management logs, accident and infection records, facility maintenance and automated systems records, access logs, security camera footage, and communication logs. In addition to documentary sources, interviews with facility personnel and observations of laboratory facilities and fieldwork sites would also be important sources of data.
The international community has limited experience of forensic investigations on the public health side, and there are many at the WHO who are apprehensive about such an inquiry, considering it technically and politically outside their scope. But COVID-19 is an unprecedented event, requiring an unprecedented response. And the international community is not completely in the dark on forensic investigations; it has plenty of experience to draw on from the security side. Of particular relevance are the interactive and on-site peer reviews that member states of the Biological Weapons Convention, the international treaty banning bioweapons activities, have voluntarily initiated to demonstrate that they operate their high-security facilities safely and securely, and that they carry out appropriate risk assessments for high-risk research, properly train their staff, and ensure accountability for any breaches. The peer reviews are based on cooperation; experts exchange information and share best practices, as they did, for instance, in 2016, when a team of international experts visited facilities at the Bundeswehr Institute of Microbiology in Munich, Germany and again in 2018, when another team visited the National Center for Disease Control and Public Health in Tbilisi, Georgia.
There have also been national investigations that might set a precedent for any WHO COVID-19 investigation. In China, for example, authorities reviewed safety lapses at labs involving Brucella in 2019 and SARS virus in 2004. UK officials, likewise, reviewed safety lapses at labs after a foot and mouth disease outbreak in 2007 and a smallpox outbreak in 1978. In the United States, officials have reviewed safety lapses involving Bacillus anthracis at a Defense lab in 2015, Bacillus anthracis and Ebola virus at Centers for Disease Control and Prevention labs in 2014, and Variola virus at Food and Drug Administration labs in 2014.
A global health security council? A COVID-19 origins investigation will need to be negotiated and begun rapidly before relevant data diminishes or disappears entirely as time passes. The investigation, most likely comprising a series of scientific and collaborative field missions, will inevitably not be ideal. And, it may ultimately not provide all the answers, though hopefully the data collected may point to a credible, coherent origin story.
The inevitable ad hoc nature of a COVID-19 origins investigation will highlight for many the future need to develop a more appropriate international body, residing at the nexus between the public health and security spheres. Such an organization, or subunit within an already established organization, would need a mandate to go in and investigate a suspected outbreak of international concern as soon as initial reports emerge, regardless of any indications of it being natural, accidental, or deliberate. Its reports could form the basis of collective action to protect global health.
In a recent speech, according to The Times, the former British foreign secretary Lord William Hague of Richmond said that animal to human virus transmission must in future be treated as a weapon of mass destruction. And just as the world has systems to monitor nuclear facilities and ban the proliferation of weapons of mass destruction, so too, Hague said, it is time for a new international order to inspect the biological threats that “pose the greatest danger to human health and the global economy.” Hague was speaking at the launch of a new report by the conservative think tank Policy Exchange which calls for “a new or strengthened co-ordinating body at the international level, ideally UN-based, to lead the monitoring, research and inspection of high-risk activities” that increase risks of zoonotic disease outbreaks. The report also calls for trade sanctions on countries that flout the rules.
Significant new thinking on international mechanisms for responding to biological threats is clearly afoot. COVID-19 might just give the international community the push it needs to do something about improved monitoring of biological risks.
Filippa Lentzos is a senior research fellow jointly appointed in the Departments of War Studies and of Global Health and Social Medicine at King’s College London. Her research focuses on biological threats and on the security and governance of emerging technologies in the life sciences. Read more at www.filippalentzos.com or follow her on Twitter @FilippaLentzos.
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