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Beginning in May 2015, Middle-East respiratory syndrome (MERS) experienced its first publicly reported “super-spreading” event in South Korea. By mid-June, more than 120 cases and 11 deaths in South Korea had been linked to a businessman returning from travel to Bahrain, United Arab Emirates, the Kingdom of Saudi Arabia and Qatar. Globally more than 1200 had been infected of whom more than 450 died—a high fatality rate of 37%.

What are the most effective legal, social, and public health responses to MERS and other emerging diseases? First, the World Health Organization’s International Health Regulations (IHR) did not effectively guide the MERS outbreak. The IHR, the governing framework for global health threats, should be amended to allow for graduated alert levels and building health system core capabilities.

Second, MERS, like all emerging health threats requires a strategic and measured public health response, including government transparency, protection of health workers and robust infection prevention and control, humane isolation and quarantine measures, travel restrictions that adhere to WHO guidance, and school closures only when strictly necessary.

Third, international rules and governance must effectively address the contentious history of “ownership” of MERS-CoV. There are glaring gaps in the international system for equitable virus sharing and assertion of intellectual property rights over biological materials and genetic viral sequences.

Finally, we propose the development of robust health systems throughout the world to contain the spread of MERS-CoV—as well as the next infectious disease threat.

Publication Citation

Lawrence O. Gostin & Daniel Lucey, Middle East Respiratory Syndrome: A Global Health Challenge, JAMA International Medicine (June 17, 2015),