Volume 38, Issue 10 Pages 2273-2432 (28 February 2020)
Editorial Full text access
Another coronavirus, another epidemic, another warning
Gregory A. Poland
Many questions must yet be answered as coronavirus vaccines are developed. Research questions whose answers have immediate and practical application include these issues:
:: Further resolution of case-fatality rates, viral reproductive number, and serosurveys that allow us to better appreciate the epidemiology of this infection
:: The identification and role of possible super-spreaders
:: Propensities for differential infection and transmission rates, as well as disease severity and fatality by age and ethnicity
:: Development of suitable animal models that closely mimic human pathophysiology and immunology must be identified and better optimized
:: Regulatory pathways for vaccine clinical trials and licensure in the absence of continuing outbreaks must be determined, as history demonstrates the intermittent and sudden appearance of outbreaks with these novel viruses—how might such regulatory pathways be altered in the event of a pandemic or more lethal mutations?
:: How shall issues of immunosensecence in the elderly and immunoimmaturity in infants and children be accounted for?
:: Why have we not seen widespread or lethal infections in children compared to adults?
:: What about special populations such as health care providers, pregnant women, immunocompromised individuals, and those with and without prior experience with various types of coronavirus infection?
:: How will such vaccines be equitably distributed—particularly in low income countries?
:: Better data on viral pathogenesis and human immune responses
As the world waits and watches, it is apparent that Chinese authorities in particular, and all countries, must take more seriously the threat of these emerging coronavirus human pathogens. Specific steps should include the following:
:: Regulate so-called wet markets with bans on the unregulated sale and trade in exotic animals.
:: Improve sanitation in such markets with food protection and hygienic standards appropriate to 21st century practices.
:: Significantly expand public health infrastructure. Among such tasks must be the regular surveillance of these markets for emerging viruses of concern.
:: Transparently, quickly, and in accordance with international health regulations, share information with global health authorities. The current outbreak is highly likely to have started in November or earlier, but it was not until late December that Chinese authorities reported to the WHO what was happening.
:: Allow, from the very beginning, health authorities from across the globe to assist in outbreak investigation and scientific investigation. It is surprising that CDC has not yet been invited to China to assist in this global issue. It is surprising to see papers from Chinese scientists that place barriers on sharing information—such as requiring “detailed study protocols and statistical and reporting plans” submitted for approval before data is shared. This is counter to the essence of professionalism and moral imperatives to openly share science for the protection of the health of the global public.