Science diplomacy and pandemics

The 2003 severe acute respiratory syndrome (SARS) pandemic is often labeled the first pandemic of the 21st century. It initially appeared in China at the end of 2002 and quickly spread to more than two dozen countries in North America, South America, Europe, and Asia. The virus that causes SARS is known as SARS-associated Coronavirus (SARS-CoV) and is highly contagious, producing sometimes fatal respiratory illnesses. It can easily spread through close person-to-person contact.[1] In 2003, the World Health Organization (WHO) reported a total of 8098 infections and 774 deaths. Only 8 tested positive for SARS-CoV in the United States at the time.[2] The collaborative efforts by organizations, countries, researchers and public health officials all over the world led to containment of the virus within about 5–6 months.[3] WHO first announced a global alert for a severe pneumonia-like disease on March 12. Measures taken by WHO ensured that consistent reports regarding countries most affected by the outbreak were received. WHO's collaboration with other organizations such as media outlets, UN agencies, and Global Outbreak Alert and Response Network (GOARN) allowed for identification of locations with new SARS cases. WHO also utilized the Global Public Health Intelligence Network (GPHIN), developed for WHO by Health Canada, to improve the speed of outbreak detection and advance the response time.[4]

Immediate action was taken to implement proper containment measures when outbreak locations were identified. WHO also partnered with GOARN to dispatch teams of experts into areas heavily impacted by SARS such as China, Hong Kong, Singapore, and Vietnam. These experts represented around 20 different organizations and 15 different nationalities and worked in several sectors to contain the virus. Epidemiologists of varied backgrounds also worked together to review the measures to control the spread of the virus as well as analyze the behavior of the virus in transmission. Such epidemiologists hailed from the Health Protection Agency (United Kingdom), the National Institute of Infectious Diseases (Japan), the Robert Koch-Institut (Germany) and more.[5] Clinicians representing over 11 countries also played integral roles in measures to fight the virus by working together to create effective treatment plans and improve infection control procedures in hospitals worldwide. Some of them were from Hõpital Universitaire de Genéve (Geneva, Switzerland), National Institute of Health (Slovenia), and Adelaide Meath and National Children's Hospital (Dublin, Ireland).[5]

In addition, researchers from laboratories around the world shared their findings with each other in hopes of gaining better understanding of the disease to test possible vaccines for SARS.[5] Along with these organizations, the Center for Disease Control and Prevention (CDC) has also closely worked with WHO throughout the course of the SARS outbreak. The CDC had promptly activated its Emergency Operations Center (EOC) just days after WHO's global alert and informed the public of this novel disease while providing precautionary protocols to avoid infection. They also established and dispatched teams of specialists of multiple backgrounds to conduct on-site investigations of SARS and carried out extensive research to test SARS specimen in order to identify its cause and transmission behavior.[2] In July, WHO officially announced that the SARS epidemic had been contained.[3]

However, even after intense efforts, no successful vaccine was created to combat SARS. In 2003, it took a considerable amount of time before the genome sequence of the virus was available and it wasn't until 2004 that possible vaccine trials were conducted in humans.[6] Researchers in a 2005 journal proposed possible methods of vaccine development noting the possibility of an inactivated SARS-CoV based vaccine. They also proposed spike (S) protein, a glycoprotein component of SARS-CoV membrane, based vaccines as well as a recombinant RBD (a fragment in S protein) based vaccines. They concluded that of these methods, RBD vaccines may be the safest means of combating SARS, though no such effective vaccine currently exists.[7] Nonetheless, collaborative efforts around SARS lead to major advancements in global public health. After SARS, the U.S. Department of Human and Health Services "amended the regulations to streamline the process of adding future emerging infectious diseases." Quarantine regulations of CDC were also revised to streamline the responsiveness to global health emergencies and "increase legal preparedness."[8]

Collaboration between the U.S and China also improved after SARS as Tommy Thompson, U.S. Secretary of Health and Human Services visited China in October 2003 and "signed a multiyear partnership with the Chinese Ministry of Health to develop a more robust public health infrastructure in China. Thompson also established an HHS health attaché at the U.S. embassy in Beijing."[9] China's overall responsiveness and preparedness to infectious disease has also significantly improved since SARS as evident by their cooperative efforts in curbing the current SARS-CoV2 pandemic. Collaborative efforts were crucial to the containment of SARS. The importance of open collaboration was acknowledged formally in May 2003 when a resolution was adopted on SARS by delegates at the World Health Assembly; it called for the full support of all countries in combating SARS along with full transparency and steadfast reporting of requested information.[10] A second resolution to improve International Health Regulations gave WHO the authority to take a much stronger role in case of infectious diseases that pose a threat to public health. This allowed WHO to act and respond to outbreaks using its own resources rather than waiting for official government notifications of outbreaks.[4]

The Western African Ebola virus epidemic took more than 11,000 lives. Science diplomats traveled the world and worked with scientists from other countries in the hope of finding a vaccine to conquer the Ebola outbreak.[11] The Ebola virus causes severe bleeding causing organ failure, lack of oxygen to the body, and it can lead to death. Scientists first discovered the Ebola virus in 1976 in Democratic Republic of Congo. Since then it has spread to other countries. It affected mostly West African countries. The largest outbreak of the Ebola virus from 2014 to 2016.[12] There were over 28,000 cases. The virus had spread to Guinea, Liberia, Guinea, Ivory Coast, Gabon, Sierra Leone, Mali, Nigeria, Italy, the United States, and more.[13] The virus spread to more than 17 countries. UNESCO played a huge role in preventing the spread of Ebola to neighboring cities and countries of West Africa. They funded $20,000 to a radio station in Sierra Leone to keep the people informed about the virus and the precautions that they could take in order to avoid it. Ebola did not spread to Koinadugu, Sierra Leone even though it borders the Republic of Guinea.[14] which had 3814 cases and 2844 deaths[15]

Moreover, the United Nations and International Non-Governmental Organizations have supported the public health response to bring an end to the Ebola epidemic in the Democratic Republic of Congo (DRC). They have made huge efforts to track the Ebola virus, to find out where it moves next in order to prevent transmission of the virus.[16] The first Ebola outbreak was discovered in the DRC in a village near the Ebola River, which gave the virus its name.[17] The 1976 Ebola outbreak was much more contained than the 2014–2016 outbreak. The 1976 Ebola outbreak lasted about 11 weeks. There were 318 cases and 280 deaths. The death rate was around 88 percent. In contrast, the Western African Ebola virus epidemic lasted more than two years, had nearly 29,000 cases and 11,310 deaths. The death rate of the Western African Ebola virus epidemic was around 50 percent.[18]

During the Western African Ebola virus epidemic, science diplomats and other medical professionals traveled around the world to help track the outbreak. They tried to reduce the number of cases and deaths of the Ebola virus by studying the disease and testing possible vaccines or treatments to contain it. Even though it looked like they were not progressing, Scientists made huge efforts to minimize the Ebola virus. They tested many vaccines and treatments. Canadian scientists had been working on the Ebola vaccine research decades before the 2014–2016 outbreak. But, they were not making huge progress because they did not have enough funding. In 2010, Lead scientists left to do other research. But, one dedicated manager kept the research going. It wasn't until the 2014–2016 outbreak that they received more funding. In August 2014, Canada donated 3.6 million dollars to the WHO and MSF. Scientists received more than 120 million dollars from the Canadian government, the US government, and the WHO to support clinical trials during the epidemic. Canada developed the first vaccine approved by the world. Millions of dollars were spent to create the vaccine and it was developed by Merck. But it would not have happened without scientists from three different continents in multiple countries.[19] The vaccine ERVEBO is used to protect against the Ebola virus. It was approved by the Food and Drug Administration in December 2019.[20] Although there are no antiviral drugs approved by the FDA to treat people who currently have Ebola,[21] there are alternative treatments such as: IV fluids, oxygen support, blood transfusions, and the vaccine ERVEBO, among others.

Zika a flavivirus (a genus of viruses in the family of Flaviviridae) and a mosquito-borne disease first identified in monkeys in the Zika forest of Uganda in 1947.[22][23] The virus primarily spreads in the wild to people through the bite of an infected Aedes aegypti mosquito.[24] Additionally, the Aedes albopictus mosquito has been shown to transmit Zika under limited environmental conditions and in laboratory settings.[25] In 1952, the first human illness caused by the Zika virus was reported in Nigeria. The first outbreak of Zika virus outside of Africa or Asia took place in 2007, within the state of Yap in Micronesia. In 2013, a large-scale Zika infection in French Polynesia and other countries and territories in the Pacific was recorded.

The WHO declared Zika a Public Health Emergency of International Concern following a series of global outbreaks and rising cases of neurological disorders in humans in 2015-2016.[26] In March 2015, Zika virus was first discovered in the Americas when Brazil reported a large spike in fine, maculopapular rashes among people, soon identified as Zika virus infection. Between January and November 2015, several Brazilian states also reported an increase in cases of Guillain-Barré syndrome.[27] Additionally, an increase in fetal microcephaly, as well as other neurological abnormalities in unborn babies, was reported in Brazil.[28] The timing on the microcephaly, the history of rash in more than half of the pregnant mothers, and the ongoing circulation of Zika in urban environments suggested a link between the neurological disorder and the virus.[29] Outside of Brazil, Zika virus was transmitted at an alarming rate and by March 2016 the virus had affected at least 33 countries and territories in America.[30][31] A public health emergency was also announced in Puerto Rico by Secretary of Health and Human Services (HHS) Sylvia Burwell at the behest of Governor Alejandro Garcia Padilla, suggesting that the ongoing outbreak of Zika virus presented a serious threat to public safety.[32] In the same year, the CDC recognized that Zika virus was not just a mosquito-borne disease; it could also be transmitted sexually between individuals. As such, the organization issued an official advisory to men who resided in or had traveled to areas with active Zika virus transmission and their sexual partners.[33] In response to Zika outbreaks within the USA, the Senate and the House of Representatives approved bills offering $1.1 billion in funding to combat Zika, which President Obama eventually signed.[34]

The global humanitarian response against Zika has occurred on many fronts, with much effort devoted to developing anti-Zika virus vaccines and therapeutics. According to The WHO, 18 companies were working on the vaccines, as of March 2016. The WHO's priority was to develop a vaccine that was safe for use by pregnant women. With that in mind, the research institutions aimed to create inactivated vaccines, which were produced by treating infectious viruses with chemicals that destroy infectivity but maintain the capacity of the virus to induce a protective immune response.[35] In 2016, The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), conducted a human clinical trial of the NIAID Zika virus investigational DNA vaccine.[36] In 2017, the phase 2/2b clinical trials were conducted, with the target of obtaining more safety and immune response against the diseases caused by Zika virus.[37] Despite these effort, to date there still is no effective vaccine available for Zika virus.

Additional support in the fight against Zika was seen from major international health organizations. The WHO issued guidelines outlined in the Zika Strategic Response Framework to effectively interfere and help families, communities and countries to control Zika virus disease.[38] The four main goals of their response plan - detection, prevention, care, and support and research - have supported national governments and communities to prevent and manage the complications of Zika virus.[39] The WHO and other international health organizations carried out further research development activities focused on diagnostic tests and innovative methods to control mosquitoes.[40] The CDC also provided an action plan to prevent the spread of the Zika virus, as well as surveillance instructions for taking precautions before and during the mosquito season. This plan detailed the development and distribution of MAC-ELISA testing kits to the US and the development of Trioplex rRT-PCR to detect Zika, dengue, and chikungunya viral RNA.[41]

On December 31, 2019, authorities in Wuhan, China reported the first cases of an unknown pneumonia to the World Health Organization (WHO). Shortly after that, on January 4, 2020, the WHO reported on social media that there had been a group of pneumonia cases in Wuhan, China but that no deaths had been reported.[42] The unknown pneumonia was a novel coronavirus, which they later named COVID-19. WHO quickly realized that it was a serious problem and issues between science and diplomacy on the topic of COVID-19 became evident. The Chinese government did not alert the WHO about the full extent of the seriousness of the outbreak.[43]

By the time the WHO realized that the problem was serious, the false information of a low mortality rate and its low risk to non-senior citizens had already spread very rapidly. The United States and the WHO tried to send scientists to help China fight COVID-19; however, China refused the help. China did eventually share the genome sequence of COVID-19 with the global community and later accepted another offer from the WHO to send a team of scientists to help. The lack of communication and the slow transmission of information between science and government caused failures to slow the spread of the virus in its early stages. To further complicate this stage, when scientists did give information or guidance, governments did not take it into proper consideration.[44] As a result, by not acting fast enough, many people were infected and local economies suffered due to the slow decision to act in unison. The overall impact on society would have been less detrimental if governments had acted in collaboration with each other and scientists.[45]

Some progress has been made among the scientific community itself in creating transparency, so local scientists in each region have access to the information they need to fight COVID-19. For example, the global scientific community began making efforts to communicate and share relevant information to help combat COVID-19 without delay. The WHO reported that a global research roadmap has been created in March 2020 to fight COVID-19.[46] Scientists are publishing research findings before they are peer-reviewed and sharing other discoveries without delay. Scientists and clinicians are working to fight the epidemic by sharing data through information sharing technologies using bioRxiv, medRxiv, ChemRxiv, and arXiv, which allows them to share information in real time.[46] These tools are helping biopharma research and development, academic labs, government regulators, and the clinical community to speed up the process of testing new pathways to treating COVID-19 patients more efficiently.[46] As one researcher explains, “We are experiencing a shift towards Open Science at a speed that was previously unthinkable. It began with the publication of the genetic sequence of COVID-19 by Chinese scientists in early January 2020 via GenBank – an open-access DNA database operated by the US National Center for Biotechnology Information”[45]

Additionally, The World Economic Forum has partnered with the WHO to mobilize and help supply the needed resources required to fight COVID-19 itself and the economic impact it is having.[47] With the sharing of this information around the world by scientific communities, each individual country is better equipped with the knowledge they need to combat the pandemic and investigate possible treatments, testing, and vaccines. In the most current WHO published table of COVID-19 vaccines, there are 124 candidates that are in different stages of vaccine development.[48]

• 2002-2004 SARS outbreak
• 2015-2016 Zika virus epidemic
• COVID-19 pandemic
• COVID-19 vaccine
• Ebola vaccine
• List of Ebola outbreaks
• SARS
• World Health Organization's response to the COVID-19 pandemic
• Zika virus vaccine
• Zika virus outbreak timeline