The COVID global health emergency is over, said WHO Director General Dr Tedros Adhanom Ghebreyessus at a press conference on Friday.  His declaration came more than 39 months after WHO first declared a public health emergency of international concern (PHEIC) on 30 January 2020 over a mysterious respiratory virus that emerged in Wuhan, China but quickly overcame countries around the world.

Speaking at a media briefing, the WHO DG warned that the disease remains a threat along with multiple other stressors threatening global health and security – from climate change to weak health systems. Taken together, these could soon lead to yet another pandemic if not forcefully addressed.

He called upon political leaders to move quickly to finalise the terms of a new Pandemic Accord being negotiated by WHO member states, as well as agreeing to revisions in WHO’s existing International Health Regulations so as to “transform that suffering” of COVID 19 into “meaningful and lasting change” with a “commitment to future generations that we will not go back to the old cycle of panic and neglect that left our world vulnerable.”

He noted that “COVID-19 turned our world upside down” with a reported death toll of seven million deaths but a likely actual death toll of close to 20 million.

And “the virus is here to stay” he stressed, warning countries not to let down their guard.

Litany of damage

In the warm-up to his announcement, the WHO DG reviewed the litter of global damage wrought by the virus that ripped like a hurricane through societies worldwide in early 2020:

“COVID has been so much more than a health crisis,” Tedros observed.  “it has caused severe economic upheaval, shaving trillions from GDP, disrupting travel and trade, shattering businesses and throwing millions into poverty.

“It caused severe social upheaval, with borders closed, movements restricted and schools shut, and millions of people experiencing loneliness, isolation, anxiety, and depression.

“COVID-19 has exposed and exacerbated political lines within and between nations.|

“It has eroded trust between people, governments and institutions, fueled by a torrent of myths and misinformation. And it has laid bare the searing inequalities of our world – with the poorest and most vulnerable communities the hardest [hit] and the last to receive vaccines and other tools.”

But in light of the steady downward trend in COVID-related mortality, brought about by a weakening virus, growing population immunity and increased vaccination rates, WHO’s COVID-19 Emergency Committee “recommended to me that I declare an end to the Public Health Emergency of International Concern (PHEIC), ” he said.  He was referring to the emergency provisions of WHO’s International Health Regulations (IHR) that legally obligate WHO members states to act on public health threats.

The Emergency Committee made its recommendation following a meeting Thursday in Geneva – the 15th such gathering since the SARS-CoV2 virus was first reported in Wuhan in early January 2020.

COVID is over as a global health emergency – but not as a global health threat

“It’s therefore with great hope that I declare COVID-19 over as a global health emergency. However, that does not mean COVID-19 is over as a global health threat,” Tedros cautioned.

“Last week COVID-19 claimed one life every three minutes – and that’s just those that we know.  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 conditions.

“This virus is here to stay. It’s still killing. And it’s still changing; the risk remains of new variants emerging that cause new surges in cases. So the worst thing any country could do now is to use this news as a reason to dismantle the systems it has built or to send the message to its people that COVID-19 is nothing to worry about.”

“This is not a signal for us to lower our guard,” added Didier Houssin, head of the WHO COVID Emergency Committee that had met Thursday and issued its recommendation to WHO for the COVID state of emergency to finally be lifted.

What the announcement does reflect, however, is that “it’s time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases,” Tedros said.

With that in mind, he said that he would deploy a “never used” provision in the WHO International Health Regulations, to establish a standing COVID Review committee to make and update recommendations to countries about management of the virus on an on-going basis.

Declaration was not unexpected

A WHO declaration on the end of the global health emergency had been anticipated for sometime, Tedros and other WHO officials speaking at the Friday briefing admitted.

“I emphasize that this is not a snap decision,” Tedros said. “It’s a decision that has been considered carefully for some time, planned for, and made on the basis of careful analysis of the data.”

WHO’s release Wednesday of an updated COVID-19 Global Strategic Preparedness, Readiness and Response Plan (SPRP) 2023-2025” had fueled speculation among seasoned WHO-watchers that an announcement was imminent.

Is the COVID Pandemic Over?

The document was billed as a guide for managing COVID “in the transition from an emergency phase to a longer-term, sustained response”.

Alongside reducing circulation of the SARS-CoV-2 virus and diagnosing and treating COVID-19, a third objective of the plan is to “to support countries as they transition from an emergency response to longer-term sustained COVID-19 disease prevention, control and management”, the WHO DG stated in a foreword.

Could this be a precursor to lifting the PHEIC tomorrow? Covid remains a deadly threat but it’s time to move from an emergency to a sustained response through strong health systems. All emergencies must end. There are heavy political & social costs to chronic states of emergency https://t.co/QF5KNTCi7G

— Lawrence Gostin (@LawrenceGostin) May 4, 2023

Worldwide, countries have also gone back to near normal – with lockdowns and social distancing giving way to packed cafes and theatres.  Masking remains visible in some venues like airports and subways – but at a voluntary bare minimum.  And government travel and emergency decrees have now been lifted in even the most COVID-wary nations, like Japan and China – the latter of which saw a big wave of cases in late 2022 after intense public protests led to the removal of most domestic restrictions.

Coincidentally or not, the United States is also set to announce an end to its national COVID emergency next week, on 11 May.  That will see the lifting of most federal COVID vaccine mandates for groups like health workers – even though the virus still remained the fourth leading cause of death in the US in 2022.

Transform the suffering into meaningful and lasting change

But even as so-called ‘normalcy’ returns, Tedros urged global health leaders to rapidly conclude negotiations on a strong Pandemic Accord, as well agreeing to amendments in the existing WHO International Health Regulations (IHR), to avoid repeating the mistakes of the COVID pandemic once more.

“One of the greatest tragedies of COVID-19 is that it didn’t have to be this way,” Tedros said. “We have the tools and technologies to prepare for pandemics better, to detect them and then to respond to them faster and to mitigate their impact.  But globally, a lack of coordination, a lack of equity, and the lack of solidarity meant that those tools were not used as effectively as they could have been.  Lives were lost that should have been.

“We must promise ourselves, and our children and grandchildren that we will never make those mistakes again,” he said describing the draft treaty and IHR revisions as representing a “commitment to future generations that we will not go back to the old cycle of panic and neglect that left our world vulnerable.

“… If we all go back to the way things were before COVID-19, we will have failed to learn our lessons.”

Huge strides made should not be lost

WHO’s Health Emergencies Executive Director Mike Ryan, echoed those sentiments noting how the COVID pandemic saw huge strides made in the expansion of national disease surveillance systems, laboratory testing, clinical care, and access to life-saving tools from new vaccines to oxygen.

“The challenge is really how to we keep up this momentum,” he observed, “because it’s not only important for COVID, it’s important for other diseases that are in circulation.

“We need the world to get into a preparedness mode,” he added.  “We can’t just keep responding and responding and responding.  We have to get the inequities out of our system.  We saw people in this pandemic literally bargaining for oxygen cannisters on the streets of major cities. This is the 21st century.  Is this what we want to witness in the next pandemic?

“We saw family members physically fighting to get their loved ones into a hospital bed.  We saw people die before they got to the emergency room. That’s the reality of our preparedness.  We talk about technology but we can’t just use technology to get out of the mess we’re in.  We have to address our systems. We have to address how we govern.  We have to address how we finance.”

Negotiating teams have just a year to reach broad consensus

Within WHO, there are two member state groups leading negotiations on a draft pandemic accord and revisions in existing WHO health emergency (IHR) rules. The two bodies, the Intergovernmental Negotiating Body (INB) and the IHR Working Group have just one more year to complete their work in line with a mandate to bring draft agreements to the World Health Assembly by May 2024.  They are planning a joint meeting soon in an effort to sort out what topics, among the multiple issues facing negotiators, would better be handled in one instrument as compared to the other.

Together, they face a formidable task in reaching WHO member state consensus over a raft of issues – from measures to ensure stricter monitoring and reporting by countries of emerging threats to more sustainable financing of developing country health systems and more equitable distributions of vaccines, medicines and other vital health tools.

Along with that, climate change, ecosystem destruction, and poorly regulated wildlife markets and trade are constantly increasing the risks of zoonotic spillover of new and resurgent diseases from animals to humans. And these are problems that the health sector cannot effectively address without the active consent and collaboration of economic and environment sectors.

Appeals to UN General Assembly to show leadership

The problems go beyond what WHO alone can handle, some leading advocates have asserted, calling for the UN General Assembly to play a more active role going forward. The UN General Assembly is scheduled to hold a high level meeting on pandemic preparedness, prevention and response on 20 September – with a civil society stakeholder meeting set for next week.

Among the voices calling for more UN-wide leadership are Helen Clark and Ellen Johnson Sirleaf, former co-chairs of the Independent Panel on Pandemic Preparedness and Response, which issued a scathing report to WHO in May 2021. On Thursday the two former co-chairs issued a new “Road Map”  calling for more assertive action by the UNGA alongside WHO.

“Bold political choices to protect the world” are needed, the report states, including UN-wide agreement on stronger international pandemic rules, equitable countermeasures and an independent monitoring body working alongside an “authoritative WHO”.

In terms of finance, at least US$10.5 billion annually is needed to support low- and middle-income countries to bring health systems preparedness up to par.  So far, only about 10% of that has been committed to a new World Bank-hosted Pandemic Fund. Debt relief for overstretched developing nations and innovative forms of climate and sustainable development finance also are critical to pandemic prevention, the report states, referring to the “Bridgetown Agenda” championed by Mia Mottley, prime minister of Barbados.

“At a time of difficult geopolitical divide, the UN General Assembly High-Level Meeting presents an historic opportunity to demonstrate the power of multilateralism and political leadership, and choose human collaboration to overcome the threat of pathogens that could materialise anywhere, anytime,” said Helen Clark, former Prime Minister of New Zealand.

“We will face new pandemic threats. The UNGA must draw on the hard lessons from COVID-19 and honour the memory of the many millions of people who have died, to commit to comprehensive reforms that leave no gaps in the system this time,” said Johnson Sirleaf, former president of Liberia.

Image Credits: Thomas Hackl/Flickr, Flickr, Peter Griffin/Public Domain Pictures.