With a surge in cases and the rapid rise of new subvariants, the COVID-19 pandemic continues to be a global health emergency posing significant risks to public health, a WHO committee of public health experts has concluded.

The statement by the COVID-19 Emergency Committee, was published Tuesday, four days after experts gathered for their 12th meeting since a COVID-19 global health emergency was first declared on 30 January 2020 under the terms of the WHO International Health Regulations.

“This is in no way over,” WHO’s Director General Dr Tedros Adhanom Ghebreyesus told a media briefing. He and his team pointed to the worldwide surge in cases driven by the Omicron BA.5 subvariant in particular.

“As the virus pushed at us, we must push back — we are in a much better position than at the beginning of the pandemic,” he said. “We have safe and effective tools that prevent infections, hospitalization and deaths. However, we should not take them for granted.” 

COVID Cases increased by 30% in last two weeks

The WHO committee cited the 30% global  increase in COVID cases over the last two weeks and the still-unpredictable evolution of key SARS-COv2 variants driving infections as key to its decision to maintaining the current level of emergency alert.

It noted that “both the trajectory of viral evolution and the characteristics of emerging variants of the virus remain uncertain and unpredictable,” according to the statement.

“The resulting selective pressure on the virus increases the probability of new, fitter variants emerging, with different degrees of virulence, transmissibility, and immune escape potential,“ the committee added.

Other concerns, it said, are the “steep reductions in testing, resulting in reduced coverage and quality of surveillance as fewer cases are being detected and reported to WHO, and fewer genomic sequences being submitted to open access platforms.”

The decline in testing, the committee noted, also could “hinder the detection of cases and the monitoring of virus evolution,” citing remarks by Dr Mike Ryan, WHO’s Executive Director of Health Emergencies.

Along with that,  “inequities in access to testing, sequencing, vaccines and therapeutics, including new antivirals; waning of natural and vaccine-derived protection; and the global burden of post COVID-19 condition,” were other factors considered. 

Speaking at the press briefing, Maria Von Kerkhove, WHO’s health emergency technical lead, said the BA.5 subvariant of Omicron is spreading “at a very intense rate at a global level” that far outpaces the other subvariants.

“We are seeing countries become concerned about this, but we feel that countries should be concerned about SARS COV-2 overall,” she said. 

Monkeypox Emergency Committee to reconvene next week

The statement on the continuing COVID emergency comes just ahead of a critical meeting of a WHO Emergency Committee on Monkeypox scheduled for the week of 18 July to determine if that outbreak should also be categorized under the IHR as a Public Health Emergency of International Concern (PHEIC).

As of today, there were some 9,200 Monkeypox cases in 63 countries, Tedros told the briefing.  

That means cases have increased by 50% in the week since WHO issued its last report on 6 July, which confirmed 6,027 cases in 59 countries. 

Those numbers represent cases reported largely outside of the the central and western African areas where the disease is endemic.  Altogether some 1,597 suspected cases were reported in WHO’s Africa Region as of mid-June, but most were unconfirmed due to a lack of testing capacity. 

Criteria for determining a monkeypox global emergency 

Tedros said the Monkeypox emergency committee will convene against next week to look at trends, counter-measures and recommendations on what countries can do. If it decides Monkeypox also constitutes a global health emergency, it would be a rare instance of WHO simulatenously confronting three global health emergencies, including Polio, designated a global health emergency since 2014. 

Key to their deliberations will be an assessment of the evolving situation in light of nine criteria, said Dr Sylvie Briand, who heads WHO’s Global Infectious Hazard Preparedness department. 

Those include questions of “increasing cases, deaths, diseases spreading outside of the initially affected community, changes in the virus and so on,” she said, noting the situation has evolved since the committee last met on June 25. “We see an increasing number of cases, we have also seen new geographies affected. So it’s worth looking at it again and see if we need to reinforce the advice.”

At the same time, Ryan said, it appears that “sexual contact is what is driving the outbreak” of Monkeypox infections in Europe and elsewhere that have occurred in circles of men who have sex with men.

He also cited evidence that transmission can occur as a result of contact with the virus on infected surfaces, particularly in health care settings.

Wild animals hunted for food are an infection risk – not supermarket purchases

Contact with virus-contaminated wild animals, hunted and killed for food, also is an important source of Monkeypox infection in central and western Africa which frequently experiences such  “zoonotic spillover” events. But food-based contamination is not an issue elsewhere, Ryan and others stressed. 

“You are not going to get the virus from food you buy in a supermarket,” Ryan stressed. 

Dr Rosamund Lewis, WHO’s Monkeypox lead, said the virus circulates in rodent populations, but also in primate populations in central Africa. “So there is potential of being exposed in the course of hunting and preparing wild game involving an infected animal,” she said.

Von Kerkhove added there are many known pathogens that are zoonotic that spill over from animals to humans, and that have epidemic and pandemic potential. Identifying and targeting such risks, she said, requires “improved surveillance in communities and on farms, and improved laboratory capacity.”

WHO recently launched a 10-year strategy for improving the genomic sequencing of pathogens with epidemic and pandemic potential. That included bringing together veterinary and public health teams in countries to figure out what Ryan described as “how can we make these two systems work better together.”

Accelerating access to genomics – first ever WHO report

The statements about the importance of genomic tracking of both COVID and Monkeypox coincided with the release of a first-ever WHO report on “Accelerating Access to Genomics for Global Health” by the new WHO Science Council.

The report, also released Tuesday, calls for less-developed countries to gain better access to genomics technologies, which not only are critical to disease surveillance but also drives much of the groundbreaking research into health treatments today.

The field of genomics uses methods from biochemistry, genetics, and molecular biology to understand and use biological information in DNA and RNA, with benefits for medicine and public health. That has especially proven relevant during the COVID-19 pandemic and with agriculture, biological research and other such uses. 

While the costs of establishing and expanding genomic technologies are declining, making them increasingly feasible for all countries to pursue, those costs can and should be further lowered, the report finds.

The report suggests using making genomic technologies more affordable for LMICs through tiered pricing; sharing of intellectual property rights for low-cost versions; and cross-subsidization, which involves using profits in one area to fund another.

“Genomic technologies are driving some of the most groundbreaking research happening today. Yet the benefits of these tools will not be fully realized unless they are deployed worldwide.” said WHO’s Chief Scientist Dr Soumya Swaminathan in a press release on the report.  

Harold Varmos, head of WHO’s Science Council., said the benefits of genomics have been illustrated in the COVID pandemic, namely, in the development of vaccines and tests and the identification of variants that continue to pose serious problems for the world.

“Genomics has been adopted in many poor countries” as costs decline, said Varmos. Nevertheless, he said, “we are concerned that the already widespread use of genomics in advanced countries should not leave low- and middle-income countries behind. WHO and member states can do more to promote the adoption of genomics.” 

Image Credits: Kevin Torres Figueroa/ US Army National Guard/ Flickr.