A camel vaccine and a behavioural safety programme are being tested together in a randomised trial across 700 camel-owning households in Jordan to see if they can stop the MERS coronavirus jumping from animals to people. MERS-CoV kills roughly one in three of those it infects, and new human cases continue to appear from contact with infected dromedary camels. No proven intervention exists for households that live and work closely with these animals. This trial directly addresses that gap by testing two approaches—a vaccine that reduces viral shedding in camels, and a package of safer handling practices, hygiene improvements, and comorbidity management—both separately and in combination. If the trial shows that either intervention, or their combination, cuts human infections, the evidence could support a sustainable, culturally appropriate deployment strategy in Jordan and other high-risk settings. The project also serves as a model for integrated human-animal health approaches that could be applied to other zoonotic threats. The work builds on a decade-long UK-Jordan-US partnership and is aligned with WHO, WOAH, and FAO priorities for pandemic prevention at the human-animal interface.
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Middle East respiratory syndrome coronavirus (MERS-CoV) is one of three deadly zoonotic betacoronaviruses to emerge globally in the past two decades. The first known MERS outbreak occurred in a hospital in Jordan in 2012. Since then, as of May 2025, a total of 2,638 cases and 957 deaths have been reported, most of them in the Arabian Peninsula. With a high case fatality rate and ongoing zoonotic transmission, MERS-CoV remains a significant public health threat and is classified by the World Health Organisation (WHO) as a priority pathogen, given its potential for large-scale outbreaks and pandemic risk. In Jordan, MERS-CoV is a recognized One Health priority by both the Ministry of Health (MoH) and the Ministry of Agriculture (MoA). This project addresses a key evidence gap by evaluating two interventions: behavioural changes and camel vaccination to reduce zoonotic MERS-CoV transmission within high-risk camel-owning households in Jordan. The study uses a randomized factorial design to evaluate the protective effects of a behavioural intervention package and camel vaccination, both separately and in combination. The behavioural intervention, which has been recently piloted successfully, promotes safer camel-handling practices, improved hygiene, and management of comorbidities, while the camel vaccination employs the MVA-MERS-S vaccine, which has been shown to reduce viral shedding in camels and to protect against camel pox. A registry of camel-owning households maintained by Jordan’s MoA will be used to recruit 700 households to randomise into the four trial arms including a control arm. Outcome measurement will include RT-qPCR testing of nasal swabs in household members, observational assessments of behaviour as well as process measures. The primary outcome will be the reduction in positive MERS-CoV RT-qPCR of nasal swabs. In addition, the trial will assess viral shedding and serological responses in camels as secondary outcomes, providing further evidence of vaccine impact and field performance. The project builds on a decade-long partnership between institutions in the UK, Jordan, and the US, combining expertise in epidemiology, virology, anthropology and community-based interventions. Our team was the first to identify MERS-CoV in dromedary camels in Jordan, providing evidence of its zoonotic transmission and identifying risk factors in both camels and humans. More recently, in a pilot trial evaluating behavioural changes to mitigate MERS-CoV exposure, our team conducted systematic community-based RT-qPCR testing of respiratory samples from members of high-risk camel-owning households, detecting multiple asymptomatic infections prior to any intervention. Despite their considerable potential, robust trials of interventions in animals to protect humans are rare. In line with One Health principles and the WHO's emphasis on integrated strategies to tackle health risks at the human-animal interface, this project represents such an approach. The anticipated outcomes are to provide actionable evidence to support the sustainable deployment of interventions in Jordan and other high-risk settings. The project prioritizes responsible research practices, including community engagement, co-leadership with Jordanian researchers, and local capacity building, ensuring interventions are culturally appropriate and sustainable. We partner with the World Organization for Animal Health (WOAH) and the Food and Agriculture Organization of the United Nations (FAO) underscoring the project’s alignment with both regional and international priorities and enhancing its potential for scalability and broader implementation. This research will not only provide critical evidence to mitigate MERS-CoV transmission and strengthen global health security but also serve as a model for addressing zoonotic diseases through integrated human-animal health approaches.
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