All passengers were evacuated from the cruise ship, Hondius, by Monday night – and a Spaniard taken to a military hospital in Madrid to quarantine has become the 11th person from the ship to test positive for hantavirus.

The evacuation was completed 10 days after the World Health Organization (WHO) was notified about the outbreak – and experts have called for a review of the global response to identify and fix “gaps and vulnerabilities in the system”.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), and Spanish President Pedro Sánchez, described the evacuation as a success and a show of international solidarity.

Hondius captain Jan Dobrogowski, described the past few weeks as “extremely challenging”, as he and 24 crew, accompanied by a doctor and nurse, sailed on to Rotterdam. 

In a social media message on Monday, Dobrogowski thanked all passengers and staff for their “patience, discipline and the kindness they showed to each other” during the outbreak, particularly commending crew members for their “courage and selflessness”.

The Hondius evacuation had not taken place in Cabo Verde as the island lacked the capacity to handle the operation, Tedros clarified at a media briefing on Tuesday.

After docking in Cabo Verde for a couple of days, the ship sailed on to Tenerife in the Canary Islands, which is an autonomous community of Spain.

Under the International Health Regulations (IHR), of which Spain is a party, “countries are required not to allow people to be stranded at sea when they have the capacity to manage the risk safely and responsibly”, said Tedros.

‘Inhumane and unnecessary’

“There were some people around the world calling for the passengers to be contained on the ship for the full quarantine period. Our view was that would have been inhumane, and unnecessary,” he added.

“We were convinced it was possible to disembark these passengers in a way that was safe for them and the people of Tenerife, and that was respectful of the human rights of the passengers and crew.”

There were almost 150 people from 23 countries on the ship for weeks, “in what must have been a very frightening situation”, said Tedros, adding that “some of the passengers were facing mental breakdown” and “have the right to be treated with dignity and compassion”.

Meanwhile, Sánchez told the media briefing: “This world doesn’t need more selfishness, nor more fear. What it needs is countries that show solidarity and want to move forward.

He also appealed for “international cooperation and organisations like the WHO to be provided with the resources to realise their work”.

More cases possible

Three people travelling on the Hondius have died from hantavirus, the last of whom died on 2 May – the day that the WHO was first notified of the cluster of cases by the UK. South African scientists identified the virus in a British man flown to the country for treatment. 

“At the moment, there is no sign that we are seeing the start of a larger outbreak,” said Tedros. “But of course, the situation could change. And given the long incubation period of the virus, it’s possible we might see more cases in the coming weeks.”

The recommended quarantine period is 42 days, which is how long the virus can take to manifest.

Each country is responsible for monitoring the health of its citizens evacuated from the ship. Some, like Australia, will require them to remain in government quarantine facilities. Others, like the US, have stated that they will allow asymptomatic citizens to isolate at home.

The WHO recommends that they “should be monitored actively at a specified quarantine facility or at home for 42 days from the last exposure, which is the 10 May, which takes us to the 21 June,” said Tedros.

Is the system working?

Ellen Johnson Sirleaf and Helen Clark, co-chairs of The Independent Panel for Pandemic Preparedness and Response, which evaluated the global response to COVID-19, said that the hantavirus outbreak has “tested the international system”, ” demonstrating its strengths and gaps.

The pair, who previously described the WHO response to COVID-19 as “analogue” in a digital age, commended the international response to the hantaviris outbreak from 2 May.

“The identification and communication of the hantavirus results from South Africa to the United Kingdom, its subsequent reporting to the WHO [on 2 May], and from WHO to countries worldwide demonstrated the importance of rapid application of the International Health Regulations,” they said.

However, between the first death on board on 11 April and 2 May, “a series of events resulted in the growth of the hantavirus outbreak”, they noted. 

“There were risks to passengers onboard, to people interacting with them on remote islands, and following the 24 April disembarkation in St Helena, to those who contacted them on land, in the air, and in their next destinations,” said Sirleaf and Clark.

“A review should determine whether a more precautionary approach could have been applied pursuant to the guidelines in the WHO Handbook for Managing Public Health Events on Board Ships. 

In a social media recording of ship’s captain Dobrogowski notifying passengers of the first death, he assures them that it was due to the man’s underlying conditions and posed no risk to other passengers.

“While sadly deaths on ships do occur, as more people embark on adventure travel to remote locations, the need to protect travellers and those in contact with them from potential exposure to pathogens will increase,” they said.

Review of outbreak planning

The co-chairs appealed to governments to “review outbreak and pandemic planning to address vulnerabilities in the system, including in shipping, marine health and death-related protocols, port management, and protection of populations in remote locations”.

They also appealed to leaders to follow “all relevant protocols for contact tracing, infection control, reporting, isolation and supportive care” to break the chain of hantavirus transmission.

Despite negotiating a Pandemic Agreement since the end of the COVID-19 pandemic, WHO member states have been unable to agree on a Pathogen Access and Benefit Sharing (PABS) annex to set out how information about dangerous pathogens should be shared.

A few weeks back, at the conclusion of the last round of PABS negotiations, Tedros called for urgency, “because the next pandemic is a matter of when, not if”.

In September, the United Nations will convene a High-Level Meeting (HLM) on Pandemic Prevention, Preparedness and Response (PPPR).

Member states need to “ensure that the Political Declaration [adopted by the HLM] includes measurable commitments to close the gaps in PPPR, including in One Health, in financing – including for surge financing, equity, monitoring, and accountability”, said Sirleaf and Clark.

Image Credits: BBC.