Member of the WHO Committee talks about possible guidelines to investigate pandemics

“One mistake, one correction”: according to Carlos Morel, a researcher from the Brazilian state of Pernambuco, former Fiocruz president and current coordinator of the Center for Technological Development in Health (CDTS), this is how the world works. Last Tuesday (23 November), after attending the first meeting of the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), a group formed by the World Health Organization (WHO), Morel defended the mass sequencing of circulating virus, an idea he hopes to gain traction with the new group. “It is important to sequence what’s out there”, he says.

Although the idea came up as a response to the pressure to identify the origin of the Sars-CoV-2, which deflagrated the COVID-19 pandemic, the group will be tracing guidelines to investigate “past, present, and future pandemics”. Morel also sees the creation of the group as a new WHO strategy to include more representativeness, as each of its 27 members comes from a different country. A tactic that may help win the trust of nations and open doors. “The WHO only goes to a country when they are invited; they don’t have police powers”, the researcher reminds us.

The Committee formed by the WHO brings together people from many different fields. How is it going to work? Will there be missions sent to other countries?

We had our first meeting today. For the time being, meetings will be held online, and the committee may be asked to travel not only to Geneva but to other countries, for inspection purposes. An initial target that everybody keeps commenting on is China [where the Sars-CoV-2 was first identified], but much negotiation will be required before we get there. First of all, because the WHO only goes to a certain country when they’re invited; the WHO doesn’t have police powers. And I think this will only happen in the medium run, because China, like all other countries, must first trust the Committee in order to want to invite it. There will be a lot of pressure to begin with China, but I think first we need to review evidence and information, and analyze the accomplishments of the former committee, which did go to China.

How is this group different from others?

This committee was formed because the WHO was under a lot of pressure. So the WHO opted for a classical solution, which is to create a committee to provide instructions. What I find interesting is that, unlike others, it did not focus solely on the technical-scientific skills of its members. It is focusing on having members from different countries. They attempted to spread things out. The group has 27 people, 27 countries. There are “advanced” countries, such as the USA, England, Australia; middle-income countries, such as Brazil; and less developed countries, like Lebanon, Cambodja. Quite a mix, not only of countries, but of experiences as well. There are specialists in infectious diseases, virology, ecology, molecular epidemiology, bioinformatics, ethics, social sciences... A wide range of skills. But they have all dealt with biosafety at some point.

So the fact they come from different countries gives the group certain independence, especially when we think of an issue such as China, that involves a political aspect?

Exactly. For me, the way they made up this committee is already proof of a new strategy being used by the WHO. The Organization realized that having science gurus who say A, B or C is not enough. It’s part of the problem. There has to be representativity. For me, what they did was practically a mini-health assembly. It’s not going to be easy, so much so that they stressed that nobody was obliged to accept.

Do you think there will be a lot of pressure?

There already is. A committee like this, especially with so much visibility and so much previous pressure... We see so many letters accusing China, or defending China, not only in the lay press, but also in scientific journals. They’re always writing “hypothesis A is right”, “hypothesis B is the true one”. I’ve attended a lot of health assemblies, often representing Brazil, so I know this has always happened. Do you want to hear a typical issue? We know the smallpox virus has been wiped out from the face of the Earth, but it still exists in a vault in the USA and in a vault in Russia. On many occasions pressure was made at the World Health Assembly to destroy the two samples. Then comes an American study saying this should not be done right now. There is huge pressure both to vote in favor of destroying the virus and against it. Brazil has always voted for the destruction of the virus, but the USA has always won, with the argument that there’s still a lot to study. Having to study it? That was before. We now have the genetic sequence of the virus; why should we keep the virus itself there?

The WHO said that those in the committee are not representing a country or an institution. That the invitation was based on personal skills. This reduces, a little, the pressure on the members. You see, [American President Joe] Biden ordered an investigation [of the Sars-CoV-2] to the CIA. If he calls on the American member of the committee, this member can simply reply: “My apologies, Mr. President, but my nomination didn’t come from you”.

How would discovering the origin of the virus influence the fight against new pathogens?

One of the interesting areas of the mandate of this committee is that it won’t focus solely on COVID-19 and the Sars-CoV-2. It will attempt to come up with guidelines to investigate the current pandemic, past pandemic, and future pandemics, the ones that are always at our doorstep. There is a series of criteria they call natural laws. For example, has a new virus appeared? Ideally, its genetic sequence should be compared with sequences of viruses that are already in circulation.

This is why I believe an important initiative was the Global Virome Project, which advocated mass sequencing. We published this project in Science, in 2018, with the goal of raising funds. It was based on the Predict Project, which did this for nine years, surveilling regions with more propensity to have a runaway virus. But when the amount of funds requested appeared, an article came up saying it was too expensive and its approach was not the best. That the best approach was not to predict, but to investigate after it happens. But once it’s happened, you’re already at a disadvantage! It was a very significant article and it damped much of that drive we had to begin sequencing. Financial losses due to COVID-19 have amounted to trillions of dollars so far. That’s much more than the resources necessary for the Global Virome Project. But, alas, that’s how the world works: one mistake, one correction. Repeat.

I believe this committee will also attempt to return to these definitions. It’s important to sequence what’s already out there. I believe we need massive sequencing work. And not just of certain regions. Take São Paulo, for instance. The sabiá virus originated from São Paulo, not from the Amazon forest. There have been various outbreaks of this arenavirus, which is very lethal.

To discover the origin of the virus, we need to know where it came from. Viruses do not appear overnight. They are modifications of existing viruses. There may be passing through an intermediary host. Swine flu, for instance, usually occurs because there are people taking care of the pigs. The flu virus has a particular feature: its genome is broken into eight little bits. These bits are able to recombine. It’s crucial to have a detailed knowledge of viruses.

The pandemic has brought many challenges with it, but it has also caused Fiocruz to grow a lot...

Fiocruz always expands during pandemics. It was created because of the yellow fever epidemic. Pandemics, epidemics are in the very DNA of Fiocruz. What is very sad to see is that while Fiocruz grows, our universities are starving. Fiocruz had that beautiful initiative, led by Mário Moreira [vice-president of Institutional Development and Management], I think, that involved receiving resources. A website was created through which Fiocruz could receive donations. The Foundation was prepared to receive R$ 100 million, and it received more than 500 million. In this sense, Fiocruz was rewarded and acknowledged for its credibility and its performance. The fact that the Foundation built a COVID-19 Hospital Center in seven weeks and brought in two large testing stations from China, one of which was installed in Rio and the other in the state of Ceará, showed that we did more than just “ok let’s get together someday and do it”: we actually did it. There’s also the issue of producing the AstraZeneca vaccine.

In terms of reputation, during the pandemic, Fiocruz has turned much more into a national institution, rather than just a Rio de Janeiro thing. Its field of influence all over Brazil has become clear. A new variant showed up in Manaus: Fiocruz Amazônia is already there. When the zika virus appeared, Aggeu Magalhães, in the state of Pernambuco, together with Celina Turchi, absolutely killed it. This is how Fiocruz has managed to survive and grow.