A new virus emerged nearly a year ago in Jordan, predominantly infecting people who live in or have traveled to the Middle East. Two days ago, the World Health Organization confirmed the fifteenth case of infection with the novel coronavirus—a family of viruses that includes both the common cold and SARS—and a fatality that brought the death count to nine. The World Health Organization has been monitoring the situation closely and has been working with agencies in member states, such as the Center for Disease Control, to better understand the public health risk posed by the virus.

Ten years ago, the SARS outbreak spurred efforts by the World Health Organization to improve global responses to health threats and crises. In November 2002, a middle-aged man went to the hospital in Foshan, China with what appeared to be pneumonia. The man recovered and returned home. It would have been an unremarkable event, except for the fact that it was likely to have been the first case of severe acute respiratory syndrome, or SARS.

Others were infected with the mystery virus, but it didn’t come to the world’s attention until February 21, 2003, when a professor of nephrology from a neighboring municipality traveled to Hong Kong. Shortly after his arrival, he realized he had the same symptoms of the patients he had been treating, so he checked himself into the local hospital. He died 11 days later.

In the wake of his death, others fell ill and took the virus with them on their travels. On March 12, 2003, the World Health Organization issued a global alert. By the beginning of April, Hong Kong reported 685 cases and 16 deaths, and the epidemic was spreading. Eventually the virus spread to Asia, North America, South America, and Europe, infecting more than 8,000 people and killing 774.

The epidemic not only renewed the debate about how countries should cooperate to combat international public health crises, but it also proved to be a success in collaboration across borders. Thirteen laboratories in 10 countries labored to identify and sequence the virus' genome, which was accomplished within a month. The World Health Organization’s Global Outbreak Alert and Response Network analyzed case reports from all countries affected by SARS in real time and helped guide management and infection control. Thanks in part to these efforts, the outbreak was declared contained by July 2003.

The rapid spread of SARS was a turning point in the World Health Organization’s International Health Regulations. Previously, the regulations had focused on just three infections diseases: cholera, pneumonic plague, and yellow fever. But the outbreaks of SARS in 2002 to 2003, then avian influenza in 2004 to 2005, lead to a revised set of International Health Regulations put in place in 2005.

The revisions provided the world with the legal framework to mount a collective defense against global threats to human health. Changes included increased mandatory reporting for a number of illnesses, better surveillance and response, and ensuring that ports of travel between countries have measures in place to prevent the spread of disease.

In a "Perspective" article published today in the journal Science, Isabelle Nuttall and Christopher Dye of the World Health Organization ask if the revisions to the International Health Regulations are adequate. “The critical test comes not from scrutiny of the legislative fine print but from the way the regulations work in practice,” they write.

The H1N1 flu pandemic of 2009 has been the biggest test so far. During the outbreak, a report reviewing how well the International Health Regulations are functioning found that the new regulations allowed for better preparation. Still, the world remained ill-prepared for a pandemic of this magnitude, or any large global, sustained threat to public health. Challenges exist today: national and local capacities called for in the regulations are still not up to standards, national legal arrangements are not always consistent with international laws, and member states still worry about maintaining their reputations when divulging information about outbreaks.

Out of 195 signatories, 119 did not meet last June’s deadline to implement core competencies to detect, assesses, inform, and respond to public health threats. Instead, those 119 asked for an extension.

The authors postulate that the novel coronavirus serves as a reminder of the threat posed by SARS a decade ago. While we cannot know what, where, or when, another major international health threat is inevitable—will we be fully prepared?

Science, 2013. DOI: 10.1126/science.1236434 (About DOIs).