'Unacceptable': Covid data withheld by China

Maria Van Kerkhove leads the World Health Organisation’s work on emerging diseases. This week, prompted by the recent disclosure of previously unreleased information from Wuhan regarding the origin of Covid-19, she's written a stinging editorial in the journal Science in which she says, "Three weeks ago, the World Health Organization (WHO) learned that scientists in China possessed data on viral samples from Wuhan that had been gathered in January 2020, which should have been shared immediately, not 3 years later, with the global research community. The lack of data disclosure is simply inexcusable." Strong language. So what data does she mean, and what should our response be?

Maria - So there's data that was collected in the Wuhan seafood market. The data that became available contained molecular evidence. There were animals in fact sold at that market. Now, that was suspected, but it wasn't confirmed. But also, some of those animals that were sold at the market were susceptible to SARS CoV 2 infection. And what that means is that there were potential intermediate hosts. And for scientists like myself and public health professionals around the world, this is a really critical finding because these viruses sometimes pass through another animal that could be at that market. We call those intermediate hosts before they infect humans. And so the data provided more clues to suggest that there were intermediate hosts at that market. And that was new information.

Chris - How did the data come to light and where had it been in the meantime?

Maria - Well, the data was generated by China CDC, and the data was submitted to GISAID, which is a platform that hosts information and data on sequences and what we call metadata. It's supplemental data that talks about the sample collection date, where those samples came from, just more information that was submitted to GISAID as part of research that was done by a group in China, which published a preprint last summer looking at the samples. And so the data existed, and the data collection, the sample collection date from those samples was January, 2020. And so the challenge that we have as a global community is that this information has existed for more than three years. And we would need this information to be shared so that it could be analysed. And that's the big story here. That's the real crux of it. And maybe you haven't heard me speak because I feel like I've been so blunt about this for so long, because this is not a game. This is about understanding how this pandemic - which has killed at least 7 million people, has disrupted every single one of our lives, has changed futures - we have to understand how this began. And data like this are critically important to be shared because by knowing this information, we take steps to mitigate, to prevent this from happening again, because unfortunately this will happen again.

Chris - The World Health Organization have performed one so far, analysis, back in 2020/21, of what is thought to have occurred to start the pandemic. Samples were requested then by the WHO and China resisted providing them and still have resisted providing them. Does this fall under that same mentality? There's something here where getting information from the source is proving very challenging. And if so, why?

Maria - You're referring to a mission that took place in January, February 2021 of international scientists and Chinese scientists to understand the origins. That was a mission specifically looking at the origins of SARS CoV 2. And they published a report in March 2021 outlining what they were able to determine. And within that report, there were a number of studies that were recommended that needed to be conducted. And it included samples at the market tracing the animals back, doing serology, which looks for evidence of past infection through antibodies of people who worked at the market within the animals themselves. And look, the start of any outbreak is incredibly challenging. And what you're majorly focused on right at the beginning is five questions. What is it? How is it spreading? What is the extent of infection? How far has it spread already? What disease does it cause and what do we do? And at the time, the cat was out of the bag so to speak; the virus was already spreading. And so a lot of the efforts early on were on putting out that fire, stopping human to human transmission, reducing the morbidity and mortality because we were seeing huge increases in deaths and hospitals were being overwhelmed. But in addition to that, there's always work that's done at that initial source or what you think is the initial source. We knew the market played a really important amplification role because most of the cases were associated with that market. So the market was closed, the market was disinfected. That was the right thing to do. But what also happens at that time is samples would be collected. Those samples were collected, we knew that was happening. That's where some of the early sequences were identified, as well as some of the early sequences from the patients. And the question is, what happened to that information? Were there studies that actually traced the animals that we now know were sold? Were these wildlife, were these domestic species? Was this legal trade or illegal trade? And that's not a blame question, it's just getting to these answers. Because we can't come away with this pandemic and say, we need better surveillance, we need better reporting. We need to actually know the exact drivers of this. Where did they come from in terms of the trade routes? What were the animal species that were there, the conditions by which they were raised, the conditions by which they were sold so that we could do better, we could prevent this from happening again. So a lot of those early days, that early work, I believe more was done. There's incredible scientific knowledge in China that this work maybe was done. And that's what we're questioning. We keep questioning has this work been done? And if so, that data needs to be shared immediately.

Chris - The World Health Organisation, though, came under criticism for almost singing from China's song sheet at the beginning. And people said, "you allowed a sort of puppet show to play out when that investigation went through because people were whisked in a stage managed way from one venue to another. And these sorts of samples and these sorts of data that were being requested, can we see some sewage samples or some blood samples from across China to try to gauge the spread?" Those sorts of samples have still not been provided. One does wonder what else is there that could be shared and should be. Why are China so resistant to giving even organisations like the WHO access to this to help prevent the next pandemic?

Maria - Yeah, I think there's a bit of rewriting of history here. Because you know what we were saying publicly, what we were saying to China, what we were saying to all of our member states, what we were saying behind closed doors, there were excessive requests for information on the cases that were known on the extent of infection, on the case definitions, on the testing that was being done, on the samples that were collected from humans, from animals, from wherever it could be. And these were requested repeatedly. As WHO, a lot of people think we can just parachute into any country we want, walk in the front door and say give us the samples. We don't have the power to go into countries and collect those samples ourselves and walk out with that. You know, that suitcase with those biohazard stickers on it that people see in the movies - that doesn't happen. And listen, I'm just as frustrated as all of you on why we don't have this access. We work all channels, scientific channels, technical channels, diplomatic channels. Again, this is not a game. We're not playing around here and saying, you know what? It would be nice to have access to this information. We need access to this information so that we can do better the next time.

Chris - One of the things that people do find very frustrating internationally is that China has form in this area, because it was even with another coronavirus that they did a similar sort of thing 20 years ago, when the first SARS emerged. There's evidence that that was circulating. And we believe China knew it was circulating for maybe six months before they told the rest of the world. It then escaped the bounds of China and there were thousands of cases. There were nearly a thousand deaths because of that. People criticised China and said, you need to be more transparent. Here we are 20 years later, and history is repeating itself now. Now we returned to the question that we really first began to address here, which is why is there this reticence to be more open? Why not share this data unless, as some claim, there's something to hide?

Maria - I mean it's beyond a health question. I think it relates to the other questions that you were asking. What are the incentives to share? And more importantly, what are the disincentives to share? Now, we're focusing right now on China, but we do have challenges with reporting information from many countries. We have outbreaks that are occurring of other pathogens over the last couple of years, over the last year in particular. And we have challenges of getting information from countries. This is a problem and a challenge that we must face, and we must work on the incentives and the disincentives. I can talk to you about why it is important for this information to be shared, why the world needs to be vigilant, why we need to act faster, why it is so much better to prevent something from happening than to try to control it and end it once it has started spreading. And I can talk to you about the financial implications and that it's much better to spend a million dollars or a billion dollars on pandemic preparedness rather than the trillions of dollars that we are spending right now on the response and on the economic impact of Covid 19. I can talk to you about governance. I could talk to you about responsibility and accountability. What I can't do is force countries to adhere to this. I do think this is why something like a pandemic accord is so important. It's a promise that we will do better, that governments will do better, that everybody has a responsibility and a collective responsibility to do better. Because forget these borders that we have within our countries. These viruses, these pathogens don't respect borders. We live in a completely interconnected world where a virus that passes from an animal to a human or passes - let's say it was a breach in biosafety or biosecurity - into humans. Once it's efficiently transmitting within humans, it can go from one part of the world to the completely opposite part of the world in 24 to 48 hours. That's why everything that we've done for Covid 19 in terms of surveillance, sequencing, improved diagnostics, sharing of information, better data management systems, better analytics, has to be maintained. Because if we dismantle these systems and say, oh, we'll just scale them up for the next time, we're living in a fantasy world. This will happen again. But we have not addressed, and we have not moved forward on this issue of transparency and sharing. And frankly, I'm very concerned that we're almost in a worse situation than we were before this pandemic began. And that is because of the politicisation. That is because no one wants to find that next pandemic virus. No one wants to be blamed for this. But collectively, as a species, we all need to be working together on this.