Is the WHO ready to end the Covid emergency? Maybe not yet

JThree years ago, the World Health Organization declared the spread of a new coronavirus – later named SARS-CoV-2, the cause of Covid-19 – to be such a threat to global health that it deserved to be designated as a public health emergency of international concern.

On Friday, an emergency committee will meet again to deliberate whether the time has come to recommend WHO Director-General Tedros Adhanom Ghebreyesus declare the global health emergency over. The final decision rests with Tedros, who usually – but not always – follows the advice of WHO emergency committees.

The rally, the committee’s 14th, comes as Covid tears apart the world’s most populous nation for the first time, after China lifted the draconian ‘zero Covid’ policy that has kept the virus at bay for nearly three years. . This factor alone could persuade the committee that now is not the time to advise Tedros to end the USPPI, a designation that grants the WHO Director-General certain powers, including the ability to make recommendations on how countries should respond.

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On Tuesday, Tedros hinted he didn’t think the time was right, noting that Covid deaths are on the rise again around the world. Over the past eight weeks, more than 170,000 such deaths have been reported, he said, adding that figure is certainly an underestimate.

“Although I do not prejudge the opinion of the emergency committee, I remain very concerned about the situation in many countries and the increasing number of deaths,” the director general said during the weekly press briefing. WHO. “While we are clearly in better shape than three years ago when this pandemic first hit, the global collective response is again under strain.”

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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 a PHEIC (pronounced “false”).

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 serious, sudden, unusual or unexpected; it has the potential to spread across borders; and this may require a coordinated international response.

The Covid is always serious, but sudden, unusual or unexpected? Not anymore. Borders have been crossed; the virus has spread globally. At this stage of the pandemic, international responses are reduced.

Yet Tom Bollyky, director of the global health program at the Council on Foreign Relations, does not expect quick action to end the USPPI. He suspects the WHO can end Covid PHEIC in 2023 – but not now.

“I think they will be particularly slow here, given a still quite high death toll, given what is happening in China,” Bollyky said, noting that in the past the WHO has not been fast to put an end to the USPPI.

The emergency committee itself, however, indicated that it was considering how to land the plane. The committee has met ten times since the USPPI Covid-19 declaration on January 30, 2020; reports from 11 of these meetings highlighted that there was unanimous agreement among committee members on the continued need for a USPPI. In the report of its last meeting in October, there was no mention of “unanimous” agreement that the pandemic still constituted a USPPI.

At the October meeting, the expert group asked the WHO staff members assisting it to set up a session where they could discuss how a USPPI could be terminated in completely safe. In particular, he asked for advice on the potential negative consequences of the end of the USPPI and whether the WHO could still issue temporary recommendations to countries on how to respond to Covid once the USPPI ends. The IHR give WHO the authority to issue temporary recommendations to countries while a USPPI is ongoing, for example, recommending countries not to put in place restrictions on cross-border travel. In theory, these recommendations are binding, but in reality the treaty has no enforcement mechanism and countries can ignore the recommendations, as the United States did recently when it instituted an obligation for travelers from China to produce a negative Covid test to enter the country.

The discussion on how to safely end a USPPI will take place on Friday, in conjunction with the emergency committee meeting, WHO spokesman Tarik Jašarević told STAT. “This is an informal technical discussion of the committee with the secretariat on the criteria for termination of the USPPI.”

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

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

Since the creation of the tool, seven USPPIs have been declared: for the H1N1 influenza pandemic in 2009; the major Ebola outbreaks in West Africa and North Kivu; the Zika epidemic; the international outbreak of mpox; and the Covid pandemic. In 2014, when rising case numbers appeared to threaten the decades-old effort to eradicate polio, a USPPI was declared for polio, which remains in place to this day.

Most past PHEICs were called in response to disease events where transmission was eventually stopped, making it easier to know when to declare an end, Aavitsland said. (Although the 2009 pandemic influenza virus did not disappear, it settled into a seasonal circulation pattern within approximately 15 months of its initial detection. Pandemic H1N1 was declared PHEIC on April 25, 2009 the PHEIC ended on August 10, 2010.)

The Covid situation is markedly different, with the virus still causing a high number of deaths – averaging around 600 a day in the US alone at this point. The rapid evolution of the virus, with a succession of variants and sub-variants that have eroded the protection against infection created by vaccine-derived and infection-induced immunity, also gives pause to people trying to assess where we are with this new virus.

“With major Ebola outbreaks, it’s easy. The USPPI ends when the outbreak is over. This epidemic, however, is not going away. The virus is here to stay,” Aavitsland said.

Still, he thinks it’s high time to put an end to Covid PHEIC.

“What will change from here [emergency committee] see you in april? And the meeting after? Several hundred million Chinese will be infected for the first time. Several hundred million Americans, Europeans, Africans and Asians will be infected for the second or third time. Etc. There’s no need to wait,” Aavitsland said.

David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, also believes the need for a PHEIC for Covid may have passed.

Heymann, who spent two decades at the WHO, was the chairman of the emergency committee that was set up to advise the global health agency on the 2015-2016 Zika outbreak. This PHEIC is the shortest on record, having been phased out in just under 10 months.

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

Is there any justification for extending the Covid PHEIC? “Based on the criteria used by the committee I chaired, no,” he said. “I see no reason to continue.”

Ending the USPPI would not be a declaration that Covid no longer poses a threat to the world, nor a declaration by the WHO that the pandemic is over.

In fact, there is unlikely to be a declaration of an end to the pandemic – not now, not later. The International Health Regulations do not include provisions for an official pandemic declaration and there is no mechanism for declaring a pandemic over. Although many experts and news outlets around the world – including STAT – interpreted Tedros’ March 11, 2020 acknowledgment that a pandemic was underway as an official statement, in reality the WHO does not state that a pandemic has started nor does it report when one is over, Maria Van Kerkhove, the agency’s top coronavirus expert, told STAT. “We don’t declare pandemics,” she said.

Nor does the USPPI give the WHO powers similar to those the US federal government acquired when it declared the new virus a national public health emergency in January 2020.

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

“What the USPPI is largely meant to do is incite and empower nation states to act. It is meant to sound the alarm, to inspire action,” Bollyky said. “What the public health emergency designation is supposed to do in the United States is empower the federal government to act. … So they are fundamentally different in that respect. Having a USPPI does not allow the WHO to do much.

Why keep it in place then? “It gives them political cover that they take this seriously,” he said.

Amanda Glassman, executive vice president of the Center for Global Development, said she believes Friday’s emergency committee decision could go either way. But whatever 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 the USPPI, yes or no, is fundamentally misaligned with the evolution of these diseases and these events,” she said, noting that the tool doesn’t seem to do what it does. has been conceived.

“PHEIC hasn’t helped us coordinate policy,” Glassman said. “I think later on we should think about this mechanism and figure out if it does what it’s supposed to do in the first place.”

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Is the WHO ready to end the Covid emergency? Maybe not yet

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