The decision after the meeting of the WHO Emergency Committee which underlined that Covid remains “a dangerous infectious disease capable of causing substantial damage to health and health systems”. However, the Committee acknowledged that the pandemic may be approaching a tipping point and that achieving higher levels of population immunity may limit the impact on morbidity and mortality. But Covid “will remain a permanent pathogen in humans and animals for the foreseeable future”.
30 GEN –
The world is in a better position but it is still too early to decree the end of the public health emergency of international interest (PHEIC) sanctioned exactly three years ago by the WHO.
The decision was made by the WHO Director-General Tedros Adhanom Ghebreyesusfollowing the conclusions of the 14th meeting of the Emergency Committee of the International Health Regulations (2005) (IHR) on the 2019 Coronavirus pandemic held last Friday.
According to the Committee, the COVID-19 pandemic “is probably in a transition phase which, however, must be tackled carefully to mitigate the potential negative consequences”.
Improved situation. Certainly the situation is much better than Omicron’s peak a year ago with more than 170,000 COVID-19 related deaths globally reported in the last eight weeks.
13.1 billion doses of COVID-19 vaccines have been administered worldwide, with 89% of healthcare workers and 81% of the elderly (over 60) completing the primary series.
Significant progress has also been made in the development of effective medical countermeasures; experience was consolidated in genomic sequencing and genomic epidemiology and in understanding how to manage the infodemic in the new information ecosystem, including social media platforms.
But, observes the WHO, “surveillance and genetic sequencing have now decreased globally, making it more difficult to trace known variants and detect new ones”.
Healthcare systems still under stress. And in the world “health systems are still grappling with COVID-19 and are taking care of patients with influenza and respiratory syncytial virus (RSV)”, all in a framework, the WHO always underlines, “of a lack of healthcare personnel and with increasingly fatigued healthcare workers”.
And while vaccines, therapies and diagnostics have been and remain critical in preventing serious disease, saving lives and relieving pressure on healthcare systems and healthcare workers globally, the response to COVID-19 “still encounters many barriers in too many countries unable to provide these tools to the neediest populations, the elderly and health workers”.
And this in a general framework in which the global risk of COVID-19 to human health and its ongoing transmission is still considered “high”, with the currently circulating SARS-CoV-2 variants of concern, including the descendant lineages of these variants plus the unexpectedly early seasonal return of influenza and RSV in some regions, burdening some already overstretched healthcare systems.
And to worry the WHO there is also a context of uncontrolled circulation of the virus due to the substantial decrease in the communication by the Member States of data relating to morbidity, mortality, hospitalization and sequencing of COVID-19.
Number of deaths still high and vaccinations at risk groups. For all these reasons, the members of the Committee expressed concern about the “still present risk of COVID-19, with a still high number of deaths compared to other respiratory infectious diseases, the insufficient diffusion of the vaccine in low- and middle-income countries, as well as in higher income countries where not all risk groups have always been reached, plus the uncertainty associated with emerging variants”.
The Committee then also noted that “pandemic fatigue and reduced public perception of risk have led to dramatically reduced use of social and public health measures, such as masks and social distancing, and that vaccine hesitancy and the continued spread of disinformation continue to be additional barriers to the implementation of crucial public health interventions”.
On the good side, although Omicron subtypes currently circulating globally are highly transmissible, there has been a decoupling of infection and severe disease compared to previous variants of concern.
On the other hand, the Committee always observes, “the virus retains the ability to evolve into new variants with unpredictable characteristics that make it necessary to improve the surveillance and reporting system of hospitalizations, admissions to intensive care units and deaths to better understand the current impact on healthcare systems and adequately characterize the clinical features of COVID-19 and the post-COVID-19 condition”.
Maintain global health emergency. Hence the decision to reiterate that COVID-19 remains “a dangerous infectious disease capable of causing substantial damage to health and health systems” which advises confirming the status of health emergency for a while longer “to maintain attention on COVID-19, considering the potential negative consequences that could result if PHEIC were terminated.”
However, the Committee acknowledged that the COVID-19 pandemic may be approaching “a tipping point” and that achieving higher levels of population immunity globally, through infection and/or vaccination, “may limit the impact of SARS-CoV-2 on morbidity and mortality” although there is no doubt that this virus “will remain a permanent pathogen in humans and animals for the foreseeable future”.
Therefore, long-term public health action is imperative, because, “although elimination of this virus from human and animal reservoirs seems highly unlikely, mitigation of its devastating impact on morbidity and mortality can be achieved but only if it remains a priority objective of world health“.
But in any case, the end of the global emergency is near and for this reason the Committee, in agreement with the WHO, agreed on the need to develop a series of actions and proposals aimed at all member states to maintain global attention and on COVID-19 following the conclusion of the PHEIC.
Pending these new indications, WHO has nevertheless issued seven new temporary recommendations:
- Maintain momentum for COVID-19 vaccination to achieve 100% coverage of high priority groups guided by evolving SAGE recommendations on use of booster doses. States should plan to integrate COVID-19 vaccination into part of life-course immunization programs . Regular collection of data and coverage reports should include both primary and booster doses. ( Global COVID-19 Vaccination Strategy in a Changing World: July 2022 update ; Updated WHO SAGE Roadmap for prioritizing uses of COVID-19 vaccines January 2023; Interim statement on use of additional booster doses of mRNA vaccines listed for emergency use against COVID-19; Statement of good practice on the use of variant-containing COVID-19 vaccines; Behavioral and social drivers of vaccination: tools and practical guidance to achieve high uptake.)
- Improve reporting of SARS-CoV-2 surveillance data to WHO. Better data is needed to: detect, evaluate and monitor emerging variants; identify significant changes in the epidemiology of COVID-19; and understand the burden of COVID-19 across all regions. States are recommended to use an integrated approach to respiratory infectious disease surveillance that leverages the global influenza surveillance and response system. Surveillance should include information from representative sentinel populations, event-based surveillance, human wastewater surveillance, serological surveillance, and animal-human-environment surveillance. WHO should continue to work with Member States to ensure adequate COVID-19 surveillance capacity and coverage to rapidly recognize any significant changes in the virus and/or its epidemiological and clinical impact, including hospitalization, so that the WHO can activate an appropriate global alert as needed. ( Public Health Surveillance for COVID-19 )
- Increase availability and ensure long-term availability of medical countermeasures. States should improve access to COVID-19 vaccines, diagnostics and treatments and consider the preparation for these medical countermeasures to be authorized outside the procedures on the Emergency Use List and within normal national regulatory frameworks. (Therapeutics and COVID-19: living guideline ; COVID-19 Clinical Care Pathway)
- Maintain a strong national response capacity and prepare for future events to avoid the occurrence of a cycle of panic and abandonment. States should consider how to strengthen the country’s readiness to respond to outbreaks, including attention to health workforce capacity, infection prevention and control, and funding of preparedness and response to respiratory and non-respiratory pathogens. (WHO COVID-19 policy briefs; Strengthening pandemic preparedness planning for respiratory pathogens: Policy brief).
- Continue to work with communities and their leaders to address the infodemic and effectively implement risk-based public health and social security measures (PHSM). Risk communication and community engagement should be adapted to local contexts and address the misinformation and misinformation that erodes trust in medical countermeasures and PHSM. States should strengthen public, media and community understanding of evolving science to encourage evidence-based policy and action. States should continue to monitor individual and public response to PHSM implementation and the uptake and acceptability of COVID-19 vaccines and implement measures, including communication strategies, to support appropriate use. (WHO Risk Communication Resources; Considerations for Implementing and Adjusting the PHSM in the Context of COVID-19).
- Continue to adjust international travel measures, based on the risk assessment, and not to require proof of vaccination against COVID-19 as a prerequisite for international travel. (Interim Position Paper: Considerations Concerning Proof of COVID-19 Vaccination for International Travelers; Policy Considerations for Implementing a Risk-Based Approach to International Travel in the Context of COVID-19 ).
- Continue to support research for improved vaccines that reduce transmission and have broad applicability, as well as research to understand the full spectrum, incidence and impact of the post COVID-19 condition and to develop relevant integrated care pathways.
January 30, 2023
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