The Lancet


Multiple authors
Aug. 15, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as it
was later named, was first identified in Wuhan, China, on Jan 7,
2020.1
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.2

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, 2020.3
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.2

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 5.4
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.4
There were at least 1952 unexplained deaths. However, the officially
reported COVID-19 mortality in the same period was 2771 deaths.5


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).6
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,7
as reported by the Ministry of Health on the basis of PCR-positive cases alone.8

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.8
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.9

This unprecedented decision was against the Constitution10
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”.10

The Science Academy, a member of the International Science Council,
has highlighted this fact.11

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.

1-11. References [see article]

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