On May 5, 2023, WHO Director-General Tedros Adhanom Ghebreyesus announced that COVID-19 no longer constituted a public health emergency of international concern (PHEIC). “For more than a year, the pandemic has been on a downward trend, with population immunity increasing from vaccination and infection, mortality decreasing and the pressure on health systems easing”, explained Tedros, in remarks to the media. He added that most countries have returned to a life similar to that before the pandemic and the WHO Emergency Committee, on whose advice the PHEIC was declared in January, 2020, was now recommending that the PHEIC be lifted. “It is therefore with great hope that I declare COVID-19 over as a global health emergency”, Tedros concluded.
A key criteria for a PHEIC is that an outbreak should be an extraordinary event. The WHO Emergency Committee decided that this criteria was no longer met for COVID-19. “It was the right decision”, commented Amesh Adalja, Senior Scholar at the Johns Hopkins Bloomberg School of Public Health (Baltimore, MD, USA). “In January 2020, this was a novel virus that was threatening the functioning of health-care systems worldwide. We did not have any medical countermeasures and we did not know very much about what we were dealing with. We are in a very different situation today”.
Paul Hunter is a Professor in Medicine at the University of East Anglia (Norwich, UK). “The whole issue in the control of COVID-19 has been one of balancing harms against benefits”, he said. “With the exception of vaccination, the interventions that have been used to suppress SARS-CoV-2 on a societal level now mainly do more harm than good. There is no need for the PHEIC”.
Two-thirds of the world's population, including 89% of health workers and 82% of adults older than 60 years, have received at least two doses of the COVID-19 vaccines. A modelling study published in The Lancet Infectious Diseases estimated that the vaccines saved 14·4–19·8 million lives in the first year of rollout. In the week ending May 8, 2023, WHO was notified of 546 435 infections with SARS-CoV-2 and 4266 deaths. Both figures were lower than for any week since March, 2020, although admittedly there is currently far less testing and reporting. “We know that the severity of SARS-CoV-2 decreases the more times you are infected, so for most people this will be an increasingly mild disease”, said Hunter.
Discontinuation of the PHEIC is largely of symbolic value. PHEICs capture attention and allow easier raising of funds, but they are not associated with any meaningful power. For US citizens, the expiration of the federal Public Health Emergency for COVID-19 on May 11 was more substantial because it implied looser surveillance and an end to free testing. In his remarks to the media, Tedros urged nations to stay vigilant. “The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that COVID-19 is nothing to worry about”, he said. “It is time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases”.
WHO estimates that SARS-CoV-2 has caused at least 20 million deaths since its emergence in late 2019. Tedros noted that the virus still kills at a rate of at least once every 3 minutes. There will be an ongoing need for improved therapies and vaccines. Efforts to track how SARS-CoV-2 is mutating should be maintained; they are necessary both for honing the vaccines and to keep abreast of any changes that could heighten the transmissibility of the virus, or the severity of COVID-19 disease. Adalja recommends wastewater monitoring. “It is non-invasive and relatively easy to do, and it would have benefits for diseases other than COVID-19”, he told The Lancet Respiratory Medicine. “We have to keep our focus on protecting the vulnerable”, said Hunter. “There are a lot of elderly people in the world who still have not been vaccinated”.
On May 3, WHO issued an updated edition of the COVID-19 Strategic Preparedness and Response Plan for 2023–25, which stressed the importance of building an evidence base for the post-COVID condition (also known as long COVID). 6% of patients who have symptomatic infections with SARS-CoV-2 are thought to have persistent symptoms. Authors of the plan pointed out that global coverage with COVID-19 vaccines remains suboptimal, especially for the booster doses. Only 52% of health workers and 35% of older populations in low-income countries have received both doses of the primary vaccination schedule. Still, the end of the PHEIC is testament to the astonishing progress of the past 3 years. “We have transformed COVID-19 into a manageable disease that does not have the ability to threaten populations as it once did. It is a remarkable achievement”, said Adalja.
© 2023 Sam Falconer, Debut Art/Science Photo Library