The World Health Organization (WHO) today declared an end to the COVID-19 public health emergency of international concern (PHEIC) put in place on January 30, 2020, a move that its director-general said is cause for celebration and reflection—but warned it doesn't mean the pandemic is over.
WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said the organization's emergency committee met yesterday for the fifteenth time and recommended that he end the PHEIC. "It's therefore with great hope that I declare COVID-19 over as a global health emergency," he said in a press conference.
"However, that does not mean that COVID-19 is over as a global health threat," he added. "Last week, COVID-19 claimed a life every 3 minutes, and that's just the deaths we know about. As we speak, thousands of people around the world are fighting for their lives in intensive care units, and millions more continue to live with the debilitating effects of post–COVID-19 condition."
As we speak, thousands of people around the world are fighting for their lives in intensive care units, and millions more continue to live with the debilitating effects of post–COVID-19 condition.
Tedros Adhanom Ghebreyesus, PhD
The WHO said in a statement that the decision was based on declining COVID-19 deaths, hospitalizations, and intensive care unit (ICU) admissions and on high levels of population immunity from vaccination and previous infections.
When the PHEIC, the highest level of alarm under international law, was declared, there were fewer than 100 reported cases and no deaths outside of China. "In 3 years since then, COVID-19 has turned our world upside down," Tedros said. "Almost 7 million deaths have been reported to WHO, but we know that the toll is several times higher, at least 20 million."
'We can't forget'
Tedros said SARS-CoV-2 is here to stay. "It's still killing, and it's still changing," he said. "The risk remains of new variants emerging that cause new surges in cases and deaths. 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."
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.
Tedros Adhanom Ghebreyesus, PhD
Rather, the end to the PHEIC means is that it's time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases. "If need be, I will not hesitate to convene another emergency committee should COVID-19 once again put our world in peril," Tedros said. "While this emergency committee will now cease its work, it has sent a clear message that countries must not cease theirs."
In response to a journalist's question about when we will know when the pandemic ends, Mike Ryan, MD, MPH, executive director of the WHO's Health Emergencies Programme, said the nature of pandemics is to persist for some time: "It took decades for the final throes of the pandemic [flu] virus of 1918 to disappear," he said. "In most cases, pandemics truly end when the next pandemic begins. I know that's a terrible thought, but that is the history of pandemics."
Maria Van Kerkhove, PhD, WHO's COVID-19 technical lead, said she was hopeful but emotional. "We can't forget the images of the hospitals, of the ICUs filled to capacity, of the images of medical gloves filled with warm water that are holding the hands of our loved ones who died with healthcare workers who ensured that they didn't die alone," she said.
"We can't forget those fire pyres, we can't forget the graves that were dug. I can't forget them. None of us here will forget them."
The WHO said Tedros will now convene an International Health Regulations Review Committee to advise on standing recommendations for the long-term management of the pandemic, considering the 2023-2025 COVID-19 Strategic Preparedness and Response Plan released this week. The goal is to reach an international pandemic accord.
For now, the WHO has issued seven recommendations:
Sustain national capacity gains and prepare for future public health events
Integrate COVID-19 vaccines into life-course vaccination programs
Compile diverse respiratory pathogen surveillance data sources
Prepare for medical countermeasures, such as vaccines and drugs, to be authorized within national frameworks to ensure long-term supply
Build strong and inclusive community risk communications and engagement
Continue to lift COVID-19 international travel-related health measures
Continue to support research
"One of the greatest tragedies of COVID-19 is that it didn't have to be this way," Tedros said. "Lives were lost that should not have been. We have the tools and the technologies to prepare for pandemics better, to detect them earlier, to respond to them faster, and to mitigate their impact. We must promise ourselves and our children and grandchildren that we will never make those mistakes again."
Experts react to announcement
In a statement, Gavi, the Vaccine Alliance, released a statement saying the world is ready to move on but "while today marks a historic
milestone, we must also be clear about the need to continue to protect our most vulnerable people, as we do for other deadly but preventable diseases," Seth Berkley, MD, Gavi CEO, said.
"Around three out of ten older adults in lower-income countries have not yet received two doses, and we know they are among those most likely to become severely ill or die from COVID-19."
On Twitter today, Lawrence Gostin, JD, director of the WHO's Organization Collaborating Center on Public Health Law & Human Rights, said he supported ending the PHEIC. "There’s wisdom in acting quickly to prevent a PHEIC from spinning out of control," he said. "There’s also wisdom in knowing when to end it and tackle a serious threat for the long term. Now it’s time to end the COVID emergency."
Declining case, death trends
The WHO's latest weekly epidemiologic update shows that nearly 2.8 million new cases and more than 17,000 deaths were reported in the past month, representing decreases of 17% and 30%, respectively, from the previous month.
"The picture is mixed at the regional level, with increases in reported cases and deaths seen in the South-East Asia, Eastern Mediterranean, and Western Pacific regions, and decreases in other regions," the update said.
The SARS-CoV-2 XBB.1.16 Omicron variant accounts for 5.7% of genomic sequences, up from 2% in the WHO's last report. XBB, XBB.1.9.1, and XBB.1.9.2 are the only subvariants showing an increasing trend.
The latest European Centre for Disease Prevention and Control weekly COVID update reports decreasing or stable trends in most countries. Increases in Bulgaria, Estonia, Finland, and France appear to have peaked or are about to do so.