Hantavirus at sea: Who has a duty of care? | DW News

Key Concepts

• Hantavirus: A rare, potentially lethal, rodent-borne disease that is not transmitted person-to-person.
• International Health Regulations (IHR): A legally binding treaty under the World Health Organization (WHO) governing the management of public health emergencies on international conveyances.
• Duty to Rescue: The legal and ethical obligation to provide aid to those in distress at sea.
• Flag State Responsibility: The legal obligations of the country under whose flag a vessel operates (in this case, the Netherlands).
• Core Capacity: The requirement for nations to maintain health infrastructure capable of managing disease outbreaks from international travelers.

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1. Overview of the Incident

The MV Hondas, a Dutch-flagged expedition vessel, is currently anchored off the coast of Cape Verde. The ship is experiencing an outbreak of a suspected Hantavirus infection. The situation has resulted in three deaths: a Dutch couple (who passed away after being evacuated to St. Helena) and a German national who died on board. A British passenger is currently in intensive care in South Africa. Cape Verdean authorities have refused to allow the remaining 150 passengers to disembark, citing the need to protect their local population.

2. Legal Framework and Obligations

Professor Lawrence Gostin, Director of the O’Neal Institute for National and Global Health Law, highlights several critical legal failures:

• IHR Compliance: Under the WHO’s International Health Regulations, ports are required to allow sick passengers to disembark unless they lack the medical capacity to treat them. If capacity is lacking, the state must coordinate the transfer of the vessel to a port that can provide care.
• Scientific Basis for Denial: Gostin argues that Cape Verde’s refusal is unlawful because it lacks a scientific basis. Since Hantavirus is rodent-borne and not transmitted person-to-person, the passengers pose no significant risk to the local population.
• The "Duty to Rescue": Both the Law of the Sea and WHO treaties mandate a duty to assist those in distress. Gostin notes that while these laws are clear, they suffer from a lack of enforcement mechanisms, as the WHO lacks the power to force a sovereign nation to accept a vessel.

3. Step-by-Step Protocol for Outbreaks

Gostin outlines the standard procedure that should be followed for international vessels:

1. Pre-Departure: The vessel must hold a valid certificate of sanitation and rodent control.
2. Reporting: Upon suspicion of an outbreak, the ship must immediately report the incident to the WHO.
3. Medical Response: The ship is responsible for providing initial care; if the condition exceeds onboard capabilities, the vessel must be directed to a port with adequate medical facilities (e.g., the Canary Islands or Portugal).
4. Epidemiological Investigation: A rapid investigation is required to identify exposure points (e.g., rodent droppings or urine) and monitor passengers through the incubation period, which can last two weeks or longer.

4. Key Arguments and Perspectives

• Failure of Global Solidarity: Gostin argues that the world is currently less prepared for such crises than it was during the COVID-19 pandemic. He cites the politicization of health, the spread of misinformation, and a decline in international cooperation as major obstacles.
• Unethical Conduct: The professor characterizes the current situation as "unethical, unlawful, and dangerous," emphasizing that the passengers are in a state of "genuine hopelessness and fear."
• Accountability: He stresses that the Dutch government (as the flag state) and the vessel operators failed in their initial duty to ensure proper sanitation and rodent control before the voyage began.

5. Notable Quotes

• "The claim of risk to your local population has to be based upon sound scientific evidence... there is no significant risk to the population of this country [Cape Verde]." — Professor Lawrence Gostin.
• "We owe a duty of care to people that are stranded in the open seas." — Professor Lawrence Gostin.

6. Synthesis and Conclusion

The MV Hondas crisis serves as a case study in the failure of international health governance. Despite the existence of the IHR, the lack of enforcement mechanisms allows nations to prioritize perceived local safety over international legal obligations. The situation highlights a critical need for:

• Enforcement Mechanisms: Moving beyond voluntary compliance to ensure nations adhere to WHO directives.
• Capacity Building: Ensuring that nations have the "core required capacities" to handle medical emergencies on ships.
• Flag State Accountability: Stricter oversight of vessels before they leave port to prevent preventable outbreaks.

The primary takeaway is that the current system is failing to protect vulnerable passengers, and without a shift toward global cooperation and scientific adherence, future outbreaks on international vessels will likely result in similar humanitarian crises.