Interference in scientific research on COVID-19 in Turkey
Authors: Hasan Bayram, Nurdan Köktürk, Osman Elbek, Oğuz Kılınç, Abdullah Sayıner, Elif Dağlı
Journal: The Lancet (2020)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as it was later named, was first identified in Wuhan, China, on Jan 7, 2020.1WHONovel coronavirus—China.https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/Date: 2020Date accessed: July 27, 2020Google Scholar Over the following months, the virus rapidly spread throughout the world. The disease, COVID-19, was characterised as a pandemic by WHO on March 11, 2020. On the same day, the Turkish Ministry of Health reported the first case in Turkey.2Ministry of Health of TurkeyCurrent status in Turkey.https://covid19.saglik.gov.trDate: 2020Date accessed: May 20, 2020Google Scholar According to the Global Initiative on Sharing All Influenza Data platform, which analyses the genomic epidemiology of SARS-CoV-2, the disease reached Turkey mainly through Iran, with whom Turkey has strong commercial and touristic ties, and Saudi Arabia, where thousands of Turkish citizens travelled to visit the holy places until mid-March, 2020.3Global Influenza Surveillance and Response SystemGenomic epidemiology of hCoV-19.https://www.gisaid.org/epiflu-applications/next-hcov-19-app/Date: 2020Date accessed: May 20, 2020Google Scholar 2 months after the first case, on May 11, 2020, the Turkish Ministry of Health declared that the number of COVID-19 cases had reached 139 771, with 3841 deaths.2Ministry of Health of TurkeyCurrent status in Turkey.https://covid19.saglik.gov.trDate: 2020Date accessed: May 20, 2020Google Scholar However, the excess mortality for Istanbul alone during this period was 4209 deaths. From 2016–19, the average number of deaths that occurred in Istanbul was 23 232 for the period of March 11 to July 5.4The Istanbul Metropolitan Municipality Death Information Inquiry.https://www.turkiye.gov.tr/istanbul-buyuksehir-belediyesi-vefat-sorgulamaDate: 2020Date accessed: May 20, 2020Google Scholar In 2020, this figure went up to 27 955 deaths. The excess mortality found between March 11 and July 5, 2020, in Istanbul was 4723 deaths.4The Istanbul Metropolitan Municipality Death Information Inquiry.https://www.turkiye.gov.tr/istanbul-buyuksehir-belediyesi-vefat-sorgulamaDate: 2020Date accessed: May 20, 2020Google Scholar There were at least 1952 unexplained deaths. However, the officially reported COVID-19 mortality in the same period was 2771 deaths.5Ministry of HealthCOVID-19 weekly situation report 29/06/2020—05/07/2020 Turkey.https://dosyamerkez.saglik.gov.tr/Eklenti/37862,covid-19-weekly-situation-report-29062020—05072020pdf.pdf?0&_tag1=8C3F5C6E9B0E4630704978AA6BB815 1EEE4AFC99Date: 2020Date accessed: July 28, 2020Google Scholar Because no other serious mass health events were recorded at that time, this discrepancy could be explained by non-compliance with WHO codes from the International Classification of Diseases (tenth edition).6WHOInternational guidelines for certification and classification (coding) of COVID-19 as cause of death.https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19-20200420-EN.pdf?ua=1Date: 2020Date accessed: May 20, 2020Google Scholar The official reporting system of Turkey only covered PCR-positive cases. As of July 27, 2020, Turkey ranks fourth in the European region for cases of COVID-19, with a total number of 225 173 patients and 5596 COVID-19 deaths,7WHOCoronavirus disease (COVID-19) situation report—117.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200516-covid-19-sitrep-117.pdf?sfvrsn=8f562cc_2Date: 2020Date accessed: July 27, 2020Google Scholar as reported by the Ministry of Health on the basis of PCR-positive cases alone.8Turkish Medical AssociationA two-months evaluation report of COVID-19 pandemic.https://www.ttb.org.tr/userfiles/files/covid19-rapor.pdfDate: 2020Date accessed: July 27, 2020Google Scholar The establishment of a scientific board and full coverage of treatment, and the encouragement of research by the Ministry of Health and funding bodies such as the Scientific and Technological Research Council of Turkey and the Health Institutes of Turkey were admirable steps taken by the authorities in the beginning of the pandemic. However, tension soon started building among the public sector and medical and scientific organisations due to the Ministry of Health's lack of transparency, its reluctance to share basic data, and its refusal to collaborate. There were also concerns about the shortage of personal protective equipment for health-care workers.8Turkish Medical AssociationA two-months evaluation report of COVID-19 pandemic.https://www.ttb.org.tr/userfiles/files/covid19-rapor.pdfDate: 2020Date accessed: July 27, 2020Google Scholar The final stroke came with the control of COVID-19 research by the Ministry of Health. Despite the great interest in research on COVID-19 in Turkey by researchers and physicians, the Turkish Ministry of Health announced a mandatory application for permission for research on COVID-19, before any application is made to ethics committees.9Ministry of HealthScientific research studies on COVID-19.https://bilimselarastirma.saglik.gov.tr/_layouts/15/BilimselYayin_Membership/login.aspx?ReturnUrl=%2f_layouts%2f15%2fAuthenticate.aspx%3fSource%3d%252F&Source=%2FDate: 2020Date accessed: July 27, 2020Google Scholar This unprecedented decision was against the Constitution10Judiciary of TurkeyCurrent version of Constitution of the Republic of Turkey including latest amendments 08.05.2017.http://www.judiciaryofturkey.gov.tr/Current-version-of--Constitution-of-the-Republic-of-Turkey--including-latest--amendmentsDate accessed: July 27, 2020Google Scholar and laws regulating research activities in Turkey. It appears that most submitted projects have been approved by the Ministry of Health, but some projects, including a large, multicentre observational study by the Turkish Thoracic Society, have been rejected without any clear explanation. The regular procedure for research activities in Turkey is well defined. In keeping with the international regulations, researchers must get approval from the independent ethics committee. The Turkish Constitution clearly states that "everyone can learn science and art freely and has the right to teach, explain, disseminate and research in these areas".10Judiciary of TurkeyCurrent version of Constitution of the Republic of Turkey including latest amendments 08.05.2017.http://www.judiciaryofturkey.gov.tr/Current-version-of--Constitution-of-the-Republic-of-Turkey--including-latest--amendmentsDate accessed: July 27, 2020Google Scholar The Science Academy, a member of the International Science Council, has highlighted this fact.11The Science AcademyDeclaration: subjecting scientific researches about COVID-19 to the notification to The Ministry of Health is inconvenient.https://bilimakademisi.org/covid-19-arastirmalari-hakkinda-bildirim-yukumlulugu-sakincalidir/Date: 2020Date accessed: July 27, 2020Google Scholar The Turkish Medical Association and other professional medical organisations made a declaration through a press conference and urged the Ministry of Health to cancel their decision. In conclusion, we, as respiratory physicians and scientists, are worried about the restrictions imposed by the Turkish Ministry of Health on independent research about the COVID-19 pandemic in Turkey, and we sincerely hope that the Ministry of Health's decision will be taken back in compliance with the Turkish Constitution. We declare no competing interests. All authors are affiliated with the Turkish Thoracic Society: HB is the President, NK is the Foreign Relations Chair, and OE is the Head of the Working Group on Health Policies, OK is the Co-Editor in Chief of the Turkish Thoracic Journal, AS is a member of the Auditing Board, and ED is a member.