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HEALTH: Responses to SARS Caught between Commerce, Community

Rahul Goswami

SINGAPORE, Jun 26 2003 (IPS) - For South-east Asians who have had to live uneasily from one mask to the next, the waning of the SARS outbreak is a relief. Piles of used masks no longer clog public rubbish bins, and health workers are breathing easier.

But the region’s defence against the Severe Acute Respiratory Syndrome has entered a new stage, after the removal by the World Health Organisation (WHO), effective Jun. 24, of the recommendation that all but essential travel to Beijing – the last area in the world still covered by this warning – be postponed.

Now, as anti-SARS measures focus on vigilance and containment, two areas of interest remain: the race to find a cure for SARS – as well the attendant commercial spin-offs – and the validity of the definition of SARS.

The hectic activity in Singapore surrounding the Jun. 20 scientific conference on SARS research held here provided an indication of the first concern regarding the commercial potential of a cure to SARS.

Research institutes, hospitals, universities and the private sector have submitted 77 research proposals with a view to securing fund grants through Singapore’s Agency for Science, Technology and Research.

The conference, which immediately followed the Jun. 18-19 global conference on SARS in Kuala Lumpur, organised by the World Health Organisation (WHO), also revealed the scale of efforts related to SARS research in this city-state that is building itself into a biotechnology hub.

Research groups here are likely to collaborate with those elsewhere, said a spokesperson for the Agency for Science, Technology and Research.

Yet the U.S. Centres for Disease Control and Prevention (CDC) and the British Columbia Cancer Agency (BCCA) in Canada, have already applied for patents on the SARS genome, thereby inviting criticism.

”As an alternative, these agencies could have published the genome, thus preventing others from being able to patent it,” wrote Dr E Richard Gold of the faculty of law in McGill University, Canada, in a recent issue of the medical journal ‘The Lancet’.

The two organisations aim to not only prevent others from patenting the genome, but also to obtain the exclusive right to use and sell molecular forms of the genome.

But there is competitive manoeuvring too. The patent option provides the U.S. and Canadian organisations more leverage in dealing with the University of Hong Kong’s Versitech Ltd – which has also applied for a patent – and indeed others that could patent various uses of and products that interact with the SARS genome.

One such organisation is the U.S.-based health care company Abbott Laboratories, which announced in June plans to market and distribute a new SARS diagnostic test kit to assist government laboratories in Asia within weeks.

The company claims that the kit – developed by German biotechnology firm Artus GmbH – can detect at early stages of the disease the coronavirus suspected of causing SARS.

However, the feverish moves to and from the patent office by research groups are not defensive patenting, according to Chee-khoon Chan, coordinator of the Citizens’ Health Initiative and associate professor at the School of Social Sciences, Universiti Sains Malaysia, in Penang. ”The U.S. biotech industry really got going when the U.S. National Institutes of Health (the American focal point for health research) decided to allow their research grantees to commercially exploit NIH-funded research findings,” he told IPS. Until that time, he said, these findings had been the intellectual property of NIH as ”public trustee”.

Dr Kalyan Banerjee, virologist and former director of the Indian National Institute of Virology, agreed: ”Patenting is bound to happen as there is huge commercial value.”

Of more immediate concern to the WHO and health authorities in China is an outbreak of Japanese encephalitis in Guangdong province, where the coronavirus that causes SARS originated. The disease is mosquito-borne, attacks the brain and the spinal cord, and is endemic to many parts of Asia. China reports thousands of cases a year.

That it has immediately followed the SARS outbreak, rapidly killed 18 children and infected over 200, and emerged in the same region where SARS began, has prompted WHO to closely monitor its progress.

Japanese encephalitis is a seasonal disease, and medical researchers are questioning whether SARS too will be seasonal, and whether it may reappear in October or November.

Much will depend on an improved diagnostic test, which Dr David Heymann, WHO’s executive director for communicable diseases, regards as a ”top priority”.

At the Kuala Lumpur meeting, Heymann warned: ”The next influenza season will result in a large number of patients with symptoms easily confused with SARS… a more precise and sensitive case definition is absolutely essential to keep health services from being overwhelmed.”

The WHO case definition is aimed at prompt isolation of any person who might have been exposed to the SARS virus. WHO continues to recommend that suspect cases be immediately isolated and remain so until either a probable diagnosis is made or another agent is determined to be the cause.

It is a definition that has worked well to contain the outbreak in this initial emergency response to the SARS outbreak, but health workers and medical researchers in the frontlines of the battle against SARS have called for a more precise definition for longer term surveillance.

Among them is a group from the Chinese University of Hong Kong. Following their study of patients in a SARS screening clinic in Hong Kong, the group concluded: ”Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital.”

Whether WHO guidelines and definitions change with a virus that has already shown its ability to mutate is unclear. Indeed, some of the criticism of the WHO from within Asia has long been that it is inflexible, not recognising differences in cultural and social perceptions of health and disease.

Dr N S Deodhar, a former additional director of General Health Services in India and member of the International Epidemiological Association, told IPS that ”the WHO has served to mystify” matters. This approach, he added, undervalues epidemiological investigation to determine transmission routes and the social and economic contexts of the disease.