Kuala Lumpur

The immediate crisis surrounding severe acute respiratory syndrome (SARS) may be subsiding, but most of the key scientific questions about the disease remain open.

These must not be forgotten, participants were told at the first global conference on SARS, held on 17–18 June in Kuala Lumpur, Malaysia. Health officials at the meeting, organized by the World Health Organization (WHO), expressed fears that as memories of the SARS outbreak fade, so too will the determination to answer outstanding questions.

Speakers at the meeting pledged to maintain the research momentum. “We are looking for a treatment; we are looking for a vaccine,” said the WHO's director general, Gro Harlem Brundtland. “We are looking for some understanding that will keep this from happening again.”

Brundtland called on governments to do more to prepare for a recurrence of the disease. “Whether it is SARS or something else, there will be new threats,” she said. Researchers at the meeting echoed her warnings against complacency, noting that previous pandemics, such as the influenza outbreak in 1918, began with a relatively light first appearance before returning later in full force.

David Heymann, the WHO's executive director for communicable diseases, called for an international research agenda on diagnostic testing, antiviral drugs and vaccines for SARS. “This is a pivot point from a short-term strategy, to a long-term strategy,” he said. But the WHO, unsure of what support it will get from member countries, has been unable to set concrete deadlines for such a strategy.

Health officials hope that the unprecedented international effort to contain and investigate SARS will act as a useful model for handling future outbreaks of other diseases. The WHO wants to build on the effort by agreeing international standards for important aspects of SARS research, such as treatments and diagnostic tests. The latter will be especially important for ruling out SARS when other respiratory diseases occur. “It will be quite a challenge,” says Klaus Stöhr, project leader for the WHO's influenza programme.

There are already dozens of tests that can identify the virus that causes SARS, but they are not yet sensitive enough to confirm infection during the early stage when patients may be passing the virus on to others. Some researchers have claimed accuracies as high as 95% for tests that can be done earlier, but so far “there have been no standards for evaluating the tests”, says Christian Drosten, a virologist at the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany. And there is surprisingly little agreement on what works and what doesn't. “The diagnostic tests are a real mess right now,” says one disgruntled researcher, who didn't want to be identified.

One obstacle is the lack of standardized SARS samples. But the WHO has now persuaded Hong Kong to make samples, including blood and sputum, available at shipping cost to both private and public researchers. Stöhr adds that the WHO is starting to distribute “gold standard” viral samples against which the WHO's collaborating centres can assess the performance of their tests.

But Brundtland and others voiced concern that the WHO's efforts alone cannot keep research momentum going as the number of SARS patients drops off. “The WHO isn't made of money,” she says. “Scientists and politicians in individual countries have to continue their efforts.”