Serial killer halted by headlines and hype

May 16, 2003

A vaccine for Sars may still be a long way off but, says Anna Fazackerley, the spread of the virus has been slowed by coverage in the press

It might seem a classic media scare. A new and deadly disease emerges in a far-off land and rapidly spreads around the world. Images of scared office workers staring out from behind face masks are joined by accounts of those who have succumbed to the mystery virus. Doom merchant "experts" issue vague predictions of global catastrophe.

To many scientists, the panic over severe acute respiratory syndrome has slipped all too neatly into the headline gap left by the end of the Iraq war. The UK is now braced for an epidemic despite the World Health Organisation reporting just six known cases here. Echoes of previous health scares surrounding mobile phones, the measles, mumps and rubella vaccine and genetically modified foods seem clear.

Yet media hype of what has been dubbed the "first epidemic of the 21st century" may prove a blessing. Jonathan Stoye, director of virology at the Medical Research Council's National Institute of Medical Research, argues that for once the press has been more of a help than a hindrance. In particular, the intensity of coverage has focused the minds of travellers to and from East Asia on possible symptoms, making them more likely to contact officials with any concerns.

"The media attention is overinflated to a degree, but it has served to put the disease in people's minds and therefore limit the spread," Stoye says.

"There has been a lot of scare mongering, but it has actually achieved real benefits."

Indeed, the race to limit the spread of the disease does seem to be having some success. Last week Singapore, Hong Kong and Toronto reported rapidly decreasing Sars transmissions. The WHO has predicted that those areas will soon follow Vietnam in becoming Sars free.

Modern communications are a key weapon in the battle to control the spread of a virus such as Sars, according to Paul Griffiths, chief executive of the UK Clinical Virology Network. "Being forewarned is forearmed," he says.

"It is better to be in there at an early stage."

Of course, one of the problems with media attention when a disease first emerges is that no one fully understands it, and uncertainty can fuel panic. Christl Donnelly, a researcher at Imperial College London who is working on an epidemiological study of Sars, believes media excitement was initially ignited because of the disease's apparent international spread.

But she says that public fears are not necessarily proportionate to the actual risk.

"People have ebola in their minds as a very scary disease, but it doesn't spread much," Donnelly says. "They were comparing Sars to HIV, but considering the massive number of people who will die (of HIV/Aids) in Africa alone, this is inaccurate. People get used to diseases - but it is easy to get scared by the unknown."

Griffiths is wary of the media and believes that coverage of the possibility that the MMR vaccine was linked to autism caused lasting damage. Nevertheless, in the case of Sars, he says the key piece of information that it was a severe respiratory infection was immediately and effectively released. This alerted hospitals, so nurses knew to rush a person with a high temperature and cold symptoms, who would normally be a low priority, to the front of the queue and put them in a room away from other patients.

The WHO is still very open about its lack of certainty about Sars. David Heymann, executive director of the organisation's communicable diseases section, told journalists: "We've always said we're building this ship as we sail it, and we don't have all the information." The WHO wants to see the policy of isolating patients continue and each case tracked backed to its source.

But while the flow of information around the world is proving an effective weapon against the disease, hopes that science may soon add drugs and vaccines to the armoury seem ill placed. Stoye argues that anyone with such expectations will be disappointed.

"What people ought to realise is how difficult it is to make a drug," he says. "Maybe scientists with all their hype about genomic sequences don't help. It's not just something we can develop overnight."

Moving from having a sequence of a microbe - as was announced for the Sars virus last week - to producing a drug to fight it is not a trivial process.

The sequence can identify possible targets for a drug, but the drug itself has still to be found. Stoye estimates it will take more than two years to develop a therapeutic treatment for Sars. Moreover, he thinks economics will inevitably get in the way of that scientific advance.

"For most viral infections, drug companies are not interested unless there is a significant guaranteed market, and I'm not sure this is," Stoye says.

And if the virus can be contained by classical epidemiological methods - helped along by the media - there will be even less reason for drug companies to intervene.

"It comes back to one of the arguments associated with Aids drugs," Stoye says. "Would shareholders of drugs companies really be happy to put up an investment of £100 million-plus in a drug that could only be used in China and where return on investment is unlikely to be high?" So although there are reports of ever-increasing numbers of Chinese cases and fears that the virus might even become endemic in the country, Stoye, like many other scientists in his field, predicts that Sars will drift out of western newspapers and out of our minds if it is controlled elsewhere.

"After all, how much does the average person on the street think about people in Africa with Aids?" he asks. "On the whole they are supremely indifferent to other people's fate."

Griffiths, however, is hopeful that when the Sars media spotlight fades, some lessons will have been learnt. "There is a danger that this will be a here-today, gone-tomorrow issue," he admits. "What we need is a more continuous focus on the problem. We need a policy for trying to deal with new infections."

Over the past two decades, new viruses have been discovered at a rate of about one a year. Griffiths is certain there will be a new Sars and very soon.

Maybe it is already here. Griffiths points out that there is an outbreak of a new avian influenza in the Netherlands at the moment, but it has received almost no international media attention outside the specialist press. The virus was first detected in animals, and chickens and pigs have been slaughtered to try to halt it. But there have already been several human cases and one vet has now died, which indicates an alarming potential for cross-species transmission.

Griffiths recently warned the House of Lords science and technology committee of potential future threats from a range of infectious diseases including the herpes simplex virus, influenza, the cytomegalovirus, viruses that cause diarrhoea and vomiting such as Norwalk, and emerging viruses such as West Nile disease. The clinical virology network that he heads aims to aid the rapid transmission of information on these infections to professionals. Griffiths is currently seeking government funding for the initiative.

The Lords science and technology committee takes the view that Sars must be a wake-up call to the UK and the rest of the world. Lord Soulsby, the committee's chair, says that in many ways we have been let off lightly by the Sars epidemic. He argues that if it had been a highly pathogenic flu virus, the results would almost certainly have been much graver.

"We need to be prepared to face many new infections," he says. "The price of freedom is constant vigilance." The committee's report into fighting infection, to be published in July, is likely to recommend much greater funding for medical research into infectious disease. This will include not only the basic study of infectious agents but also immunology, epidemiology and public-health procedures.

"We are geared up to deal with Sars at present," Lord Soulsby says. "I hope that doesn't mean that once it's over we go back to a paucity of funding in medical research."

As WHO experts have been stressing, we must remain watchful. It seems that Sars may not be the "big one" that virologists have led us to expect. But that may well be just around the corner, and then the media's hyperbole may not be sufficient to keep us safe.

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