WHO Statement on the 15 meeting of the International Health Regulations (2005) Emergency Committee regarding the COVID-19 pandemic

The International Health Regulations (2005) (IHR) Emergency Committee convened its fifteenth meeting regarding the COVID-19 pandemic on Thursday, May 4, 2023, from 12:00 to 17:00 CET. The report of that meeting is being forwarded by WHO Director-General with pleasure. The committee members brought up the declining trend in COVID-19 fatalities, the decrease in COVID-19-related hospitalizations and intensive care unit admissions, and the high levels of SARS-CoV-2 community immunity during the deliberative session.

The posture of the Committee has changed during the past few months. They suggested that it is time to move on to long-term management of the COVID-19 pandemic notwithstanding the lingering uncertainty caused by the likely emergence of SARS-CoV-2. The WHO Director-General agrees with the Committee’s recommendations in relation to the ongoing COVID-19 epidemic. A public health emergency of international concern (PHEIC) is no longer present due to COVID-19, according to his assessment. It is now an established and persistent health problem.

The recommended Temporary Recommendations were released as per the statement below after the WHO Director-General took into account the Committee’s opinion. In accordance with the 2023–2025 COVID-19 Strategic Preparedness and Response Plan, the WHO Director-General will convene an IHR Review Committee to provide advice on Standing Recommendations for the long-term management of the SARS–CoV-2 pandemic. States Parties are urged to keep adhering to the published Temporary Recommendations during this transition.

The Director-General conveyed his profound appreciation to the Chair, the Committee’s Members, and its Advisors for their participation and counsel throughout the previous three years.

Proceedings of the meeting

Dr. Tedros Adhanom Ghebreyesus, the director-general of the WHO, welcomed the Emergency Committee’s members and advisors, who had gathered by videoconference. The WHO surveillance reporting has drastically decreased, availability to life-saving interventions is still not equally distributed, and pandemic weariness is still increasing, he said, while noting that the number of weekly reported fatalities and hospitalizations is still down.

The COVID-19 Strategic Preparedness and Response Plan, aimed to help countries transition to long-term management of COVID-19, was published, according to an announcement made by the Director-General. The five categories covered by this plan are: cooperative surveillance, community protection, safe and scalable care, access to countermeasures, and emergency coordination.

The Committee Members and Advisors were briefed by the Office of Legal Counsel’s representative on their duties and authority under the pertinent IHR articles. The Department of Compliance, Risk Management, and Ethics’ Ethics Officer reminded Members and Advisers of their obligation to maintain the secrecy of Committee discussions and deliberations as well as their personal obligation to promptly disclose to WHO any interests of a personal, professional, financial, intellectual, or commercial nature that might give rise to a perceived or actual conflict of interest.

There were no apparent conflicts of interest for the present Members or Advisors. Professor Didier Houssin, Chair of the Emergency Committee, gave an overview of the meeting’s goals, which included reviewing Temporary Recommendations to States Parties and giving input to the WHO Director-General on whether the COVID-19 pandemic still qualifies as a PHEIC.

While the overall risk assessment is still considered high, there is evidence that the risks to human health are decreasing. This is primarily due to the high population-level immunity from infection, vaccination, or both; the consistency of the virulence of the SARS-CoV-2 Omicron sub-lineages that are currently circulating in comparison to the Omicron sub-lineages that were previously circulating; and improved clinical case management. Since the start of the pandemic, these variables have helped to cause a large global drop in the number of COVID-19-related deaths, hospitalizations, and admissions to intensive care units.

Even while SARS-CoV-2 is still changing, the variants that are now in circulation do not seem to be linked to an increase in severity. The WHO delivered updates on the state of immunization globally and discussed the ramifications of potentially terminating a PHEIC. According to information provided to the Committee, 13.3 billion doses of the COVID-19 vaccine have been given worldwide.

Although coverage in these priority groups varies by area, as of right now, 89% of health professionals and 82% of persons over 60 have finished the primary series (the initial one or two doses recommended as per the vaccine schedule).

The WHO Secretariat gave brief summaries of the integration of COVID-19 surveillance into the Global Influenza Surveillance and Response System, as well as opportunities to streamline this process, the procedure for issuing Standing Recommendations under the IHR, and the potential regulatory repercussions for Emergency Use Listed (EUL) when a PHEIC is terminated, as requested by the Committee.

Access to vaccines and diagnostics that have previously received an EUL shouldn’t be impacted by the termination of the PHEIC because the Director-General will still be able to authorize the use of the EUL method. States Parties will still have access to these vaccines and diagnostics (as long as the producers keep making them). In accordance with demand, COVAX will also continue to offer subsidized doses and delivery assistance into 2023.

A smooth transition from EUL to prequalification of vaccines and diagnostics may be possible because to this continuity. The termination of a PHEIC should have no impact on the regulatory status of the vast majority of therapies used to treat COVID-19 as these drugs are repurposed medications previously licensed for other purposes.

Deliberative Meeting on the PHEIC’s Status

The Committee thought about whether COVID-19 still met the three requirements for a PHEIC: 1) an extraordinary incident, 2) a risk to the public health of other States due to its international spread, and 3) a probable need for a coordinated international response. They talked about the COVID-19 pandemic’s current state. They admitted that even though SARS-CoV-2 has spread widely and will continue to do so, it is no longer an exceptional or unanticipated occurrence. The Committee acknowledged that, should the need arise, the Director-General may choose to call a subsequent meeting of the IHR Emergency Committee on COVID-19.

Countries have been encouraged by the COVID-19 PHEIC to improve their functional capabilities, notably in relation to emergency coordination, cooperative surveillance, clinical treatment, and risk messaging and communication engagement. Since the PHEIC was announced in January 2020, there has been a notable and amazing global advancement. It is a testament to global health cooperation and commitment that COVID-19 has advanced to the point where it can no longer be regarded as a PHEIC.

The Committee discussed the pros and cons of keeping the PHEIC, as it has done in previous meetings. The PHEIC has been a helpful tool in aiding the international response to COVID-19, but the Committee decided that it is now time to focus on the long-term management of SARS-CoV-2 as a continuing health concern.

The Committee recommended that, going ahead, the Director-General take into account forming an IHR Review Committee to provide guidance on standing recommendations for long-term risks posed by SARS-CoV-2 while taking into account the 2023–2025 COVID-19 Strategic Preparedness and Response Plan. The Committee also acknowledged that Member States are currently debating changes to the IHR, negotiating the Pandemic Prevention, Preparedness and Response Accord, and taking into account the ten proposals to fortify the Global Architecture for Health Emergency Preparedness, Response, and Resilience (HEPR).

They stressed that this is not the time to halt operations or dismantle systems and praised the WHO Secretariat and States Parties for their steadfast commitment and technical know-how. The Committee emphasized the importance of filling in the gaps discovered during the pandemic. They emphasized the need for improved health systems, ongoing proactive risk communication and community involvement, the implementation of a One Health strategy to readiness and response, and the integration of COVID-19 surveillance and response operations into regular health programs.

The Committee urged WHO, partners, and States Parties to give readiness and resilience for new risks ongoing attention and resources.

The WHO Director-General has issued temporary recommendations to all States Parties

1. Maintain the advances in national capacity and get ready for next events to prevent a cycle of panic and neglect. States Parties should think about how to increase national preparedness for upcoming outbreaks. States Parties should update their respiratory pathogen pandemic preparedness plans in accordance with WHO recommendations and take into account the lessons from global and regional after action reviews. States Parties should keep reestablishing health initiatives that have been negatively impacted by the COVID-19 epidemic.

  • Preparedness and resilience for Emerging Threats;
  • Strengthening pandemic preparedness planning for respiratory pathogens: policy brief;
  • WHO COVID-19 policy briefs;
  • Emergency Response Reviews

2. Include COVID-19 vaccination in programs for life-course immunization. States Parties shall keep working to expand the coverage of COVID-19 vaccination with WHO-recommended vaccinations for all individuals in high-priority categories (as defined by the SAGE Roadmap of April 2023) and continue to actively engage communities on vaccine acceptance and demand concerns.

SAGE Roadmap (Updated March 2023); Good Practice Statement on the Use of Variant-Containing COVID-19 Vaccines; Continued Collaboration with IVAC and Others to Summarize VE Studies; Global COVID-19 Vaccination Strategy in a Changing World (July 2022 Update); Tools and useful advice for obtaining high uptake: Behavioral and social drivers of vaccination.

3. Integrate data from several respiratory pathogen surveillance data sources to provide a complete picture of the situation. States Parties must continue to provide WHO with data on mortality, morbidity, and variant surveillance. A suitable mixture of representative sentinel populations, event-based surveillance, human wastewater surveillance, sero-surveillance, and surveillance of certain animal groups known to be at risk for SARS-COV-2 should be used in surveillance. States Parties should make use of the WHO Global Coronavirus Laboratory Network (CoViNet) and the Global Influenza Surveillance and Response System (GISRS).

COVID-19 public health surveillance

4. Get ready for national regulatory frameworks to authorize medical countermeasures in order to guarantee their supply and long-term availability. In order to facilitate the long-term authorisation and use of vaccinations, diagnostics, and medicines, States Parties should enhance their regulatory authorities.

the COVID-19 Clinical Care Pathway, the COVID-19 Emergency Use Listing processes, and the vaccine prequalification procedures;
Procedures for in vitro diagnostic prequalification

5. Keep collaborating with local governments and leaders to develop effective infodemic management and risk communication and community engagement (RCCE) programs. The strategies and measures for managing RCCE and infodemics should be adjusted by State Parties to local conditions.

6. Continue to remove COVID-19-related health restrictions for foreign travel based on risk assessments, and stop requiring any documentation of COVID-19 immunization as a requirement for international travel.

7. Continue to support research to develop vaccines that reduce transmission and have widespread applicability; to comprehend the full spectrum, incidence, and impact of post-COVID-19 condition; and the evolution of SARS-COV-2 in immunocompromised populations. Interim position paper: considerations regarding 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.

More About International Health Regulations

The International Health Regulations (IHR) are a legally binding instrument of international law that aim to prevent, protect against, control, and respond to the international spread of disease. The IHR were first adopted by the World Health Assembly in 1969 and revised in 2005 to better address emerging global health threats.

Under the IHR, all WHO member states are required to notify the organization of any events that may constitute a public health emergency of international concern (PHEIC), which includes the occurrence of any new or unusual disease outbreaks. The IHR also outline specific measures that states must take to prevent and control the spread of disease, including disease surveillance, reporting, and response.

The IHR provide a framework for coordinated international action in response to public health emergencies, such as the COVID-19 pandemic. In response to the COVID-19 pandemic, the WHO declared a PHEIC on January 30, 2020, and has since provided guidance and support to member states in their response efforts, in accordance with the IHR.

More About WHO

WHO stands for the World Health Organization, which is a specialized agency of the United Nations that is responsible for promoting health and well-being globally. It was founded on April 7, 1948, and is headquartered in Geneva, Switzerland.

The WHO has a broad mandate that includes a range of activities related to public health, such as disease prevention and control, health promotion, and research. The organization works with member states and partners around the world to develop and implement policies and programs that improve health outcomes, especially in low-income and middle-income countries.

Some of the key areas of focus for the WHO include combatting infectious diseases like HIV/AIDS, tuberculosis, and malaria, improving maternal and child health, addressing noncommunicable diseases like cancer and diabetes, and responding to public health emergencies and disasters.

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