Is WHO ready to end the Covid emergency? maybe not now

TeaThree years ago, the World Health Organization declared that the outbreak of a new coronavirus outbreak – later named SARS-CoV-2, the cause of COVID-19 – poses such a threat to global health that it declared a public health Merges the designation as an emergency. international concern.

An emergency committee will meet again on Friday to discuss whether it is time to recommend to WHO Director-General Tedros Adhanom Ghebreyesus that he declare a global health emergency. The final decision rests with Tedros, who usually – though not always – follows the advice of the WHO’s emergency committees.

The gathering, the committee’s 14th, comes as Covid rips through the world’s most populous country for the first time, after China lifted a draconian “zero Covid” policy that kept the virus at bay for nearly three years . That factor alone may persuade the committee that this is not the time to advise Tedros to end PHEIC, a designation that gives the WHO director-general some powers, including issuing recommendations for how countries should respond. Including the ability to

Advertisement

On Tuesday, Tedros indicated that he does not think the timing is right, given that Covid deaths are rising again globally. Over the past eight weeks, more than 170,000 such deaths have occurred, he said, adding the figure is almost certainly an underestimate.

“While I will not prioritize the advice of the emergency committee, I am deeply concerned by the situation in many countries and the rising number of deaths,” the director-general said during the WHO’s weekly press briefing. “While we are clearly in a better position than we were three years ago when this pandemic first struck, the global collective response is once again under strain.”

Advertisement

Whatever Friday’s decision — which likely won’t be revealed until Monday — outside experts acknowledge that the COVID pandemic may no longer strictly meet the criteria for PHEIC (pronounced “fake”).

Under the International Health Regulations (IHR), a binding international treaty, a public health emergency of international concern can be declared in the face of a health event that meets three criteria: it is severe, sudden, unusual or unexpected; It has the potential to spread across borders; And it may require a coordinated international response.

Covid is still serious, but sudden, unusual or unexpected? is no more. limits have been crossed; The virus has spread across the planet. At this point in the pandemic, international responses are being lackluster.

Still, Tom Bolicki, director of the global health program at the Council on Foreign Relations, doesn’t expect quick action on ending PHEIC. they doubt WHO May END THE COVID PHEIC IN 2023 — BUT NOT NOW.

“I think they’ll be particularly slow here, given what’s happening in China, there could still be a lot more fatalities,” Bolicki said.

However, the emergency committee itself has indicated that it is considering how to land the plane. The Committee has met a dozen times since the announcement of the COVID-19 PHEIC on January 30, 2020; Reports from 11 of those meetings emphasized that there was unanimous agreement among committee members of the ongoing need for the PHEIC. In the report of its most recent meeting in October, there was no mention of “unanimous” agreement that the pandemic still constituted a PHEIC.

At its October meeting, the expert panel asked WHO staff, who assist it, to set up a session to discuss how PHEIC could be safely eliminated. In particular, it sought advice on the potential negative consequences of ending PHEIC and whether WHO can still issue temporary recommendations to countries on how to respond to COVID after PHEIC ends. The IHR gives the WHO the power to issue temporary recommendations to countries while a PHEIC is ongoing, for example, recommending countries not impose cross-border travel restrictions. In theory those recommendations are binding, but in reality the treaty has no enforcement mechanism and countries can and do ignore the recommendations, as the United States did recently when it barred travelers from China from entering the country. A negative Covid test was required.

WHO spokesman Tarik Jasarevic told STAT that how to safely end the PHEIC will be discussed on Friday in conjunction with the emergency committee meeting. “This is an informal technical discussion of the Committee with the Secretariat on the criteria for eliminating the PHEIC.”

One of the problems for this committee and for WHO is that while there are guidelines for when a PHEIC can be declared, there are none for when one should be terminated.

“There is certainly no defined path to when a PHEIC is no longer a PHEIC,” said Preben Avitsland, state epidemiologist at the Norwegian Institute of Public Health.

Since the tool was created, seven PHEICs have been declared: for the H1N1 flu pandemic in 2009; the large West African and North Kivu Ebola outbreaks; Zika outbreak; international mpox outbreak; and the Covid pandemic. In 2014, when increasing cases came as a blow to the decades-old effort to eradicate polio, a PHEIC was declared for polio, which remains in place to this day.

Aavitsland said most of the earlier PHEICs were called in response to disease events where transmission was eventually stopped, making it easier to know when to declare an end. (Even though the 2009 flu pandemic virus did not disappear, it had settled into a seasonal circulation pattern within about 15 months of its initial detection. The H1N1 pandemic was declared a PHEIC on April 25, 2009; the PHEIC on August 10 was abolished. 2010.)

The Covid situation is markedly different, with the virus still causing a high number of deaths – averaging about 600 per day in the US alone at this point. The rapid evolution of the virus, with a succession of variants and subvariants that eroded the protection against infection created by vaccine-derived and infection-induced immunity, also gives people pause to try to assess how much we can do with this new virus. Where do you stand with

“It is easy with the major Ebola outbreak. The PHEIC ends when the outbreak ends. However, this outbreak does not disappear. The virus is here to stay,” Avisland said.

Still, he believes the time has come to end the Covid PHEIC.

“What will change between now and the next [emergency committee] meeting in April? And after the meeting? Several hundred million Chinese will be infected for the first time. Several hundred million Americans, Europeans, Africans and Asians will be infected a second or third time. And so on. There’s no need to wait,” Avisland said.

David Hayman, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, also believes that the need for PHEIC for Covid may have been overstated.

Hayman, who spent two decades at the WHO, was chair of the emergency committee set up to advise the global health agency on the 2015-2016 Zika outbreak. That’s the shortest PHEIC on record, having been closed in just under 10 months.

“When we understood that the WHO had a control mechanism in place for Zika, and when they had an advisory group that could handle Zika recommendations for them, we felt that the public health emergency of international concern was over, Heyman said.

Is there any justification for prolonging the COVID PHEIC? “Based on the criteria the committee I chaired, no,” he said. “I can’t see the reason for it to continue.”

Ending PHEIC would not be a declaration that COVID is no longer a threat to the world, nor would it be a declaration by the WHO that the pandemic is over.

Indeed, the end of the pandemic is unlikely to be declared – not now, not later. International Health Regulations do not include provisions for the formal declaration of a pandemic and they do not have a mechanism to declare that one has ended. Although many experts and news outlets around the world, including STAT, interpreted Tedros’s admission on March 11, 2020, as a formal announcement that a pandemic was underway, in fact the WHO does not declare that a pandemic has begun. Nor does it indicate when one has ended, Maria Van Kerkhove, the agency’s chief coronavirus expert, told STAT. “We do not declare a pandemic,” she said.

PHEIC also does not grant the WHO powers that are similar to those acquired after the US federal government declared the new virus a national public health emergency in January 2020.

(Health and Human Services Secretary Javier Becerra renewed the public health emergency declaration on January 11, the provision’s 13th extension. It is widely expected that the latest extension will be the last, and Becerra will announce in early February that the federal government will will allow the state of emergency to end.)

“The main purpose of the PHEIC is to inspire and empower nation states to act. It’s there to warn, it’s there to inspire action,” Bolicki said. “What the public health emergency designation is meant to do in America is empower the federal government to act. … So they’re fundamental in that regard.” are fundamentally different. Being a PHEIC does not entitle the WHO to do much.”

Then why keep it in place? “It gives them political coverage that they are taking this seriously,” he said.

In her view, Friday’s emergency committee decision could go either way, said Amanda Glassman, executive vice president of the Center for Global Development. But regardless of what the group decides, she said, one thing has been made clear by the COVID pandemic – the PHEIC mechanism needs an overhaul.

“The whole binary nature of PHEIC, yes or no, is fundamentally inappropriate for the development of these diseases and these events,” she said, noting that the tool does not do what it was designed to do.

“PHEIC didn’t help us coordinate the policy,” Glassman said. “I think afterwards, we should consider this mechanism, and whether it is doing what it should have been doing in the first place.”

Get your daily dose of health and medicine every week with STAT’s free newsletter Morning Rounds. Register here

Leave a Comment