The end of COVID-19 public health emergency of international concern (PHEIC): And now what?

Torner, Núria

doi:10.1016/j.vacune.2023.05.001

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "164" "paginaFinal" => "165" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Núria Torner" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Núria" "apellidos" => "Torner" "email" => array:1 [ 0 => "nuriatorner@ub.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "CIBER Epidemiología y Salud Pública CIBERESP, Madrid, España" "identificador" => "af0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El fin de la emergencia internacional de salud pública por COVID-19: ¿y ahora qué?" ] ] "textoCompleto" => "A public health emergency of international concern (PHEIC) was defined in the 2005 International Health Regulations (IHR) as “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”. It implies that the situation at stake is unusual, serious and of sudden onset. It determines implications that affect public health beyond the national border of the state where the emergency is detected; and may require immediate international collaborative action. The IHR are an instrument of international law that is legally-binding on 196 countries, including the 194 WHO Member States. The IHR grew out of the response to deadly epidemics yet the new 2005 IHR also imply other nature of events besides predefined infectious diseases. They create rights and obligations for countries, including the requirement to report public health events and they outline the criteria to determine whether or not a particular event constitutes a PHEIC. Such criteria include whether the public health impact of the event is serious, unusual or unexpected or whether there is significant risk of international spread and of travel or trade restrictions.<a class="elsevierStyleCrossRef" href="#bb0005">1</a>According to these criteria, following the recommendations of the Emergency Committee, the WHO Director General on May 5th 2023, declared an end to the COVID-19 public health emergency of international concern (PHEIC) which was active since January 30th, 2020. However, the entire world has to be aware that COVID-19 is not over as a global health threat, on the contrary, it is here to stay and there are still millions of severe cases and deaths occurring worldwide.The decision of May 5, 2020 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.<a class="elsevierStyleCrossRef" href="#bb0010">2</a>The toll during these 3 years mounts to almost 7 million deaths reported to WHO, yet the number could reach at least 20 million.<a class="elsevierStyleCrossRef" href="#bb0015">3</a> The constantly emerging new variants<a class="elsevierStyleCrossRef" href="#bb0020">4</a> warrant the need to stay vigilant and by no means send the message that COVID-19 is nothing to worry about. The end to the PHEIC meaning that it is time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases.A fourth edition of the Global Strategic Preparedness and Response Plan for COVID-19 has been recently published which outlines critical actions in five core areas: collaborative surveillance, community protection, safe and scalable care, access to countermeasures, and emergency coordination.<a class="elsevierStyleCrossRef" href="#bb0025">5</a>In addition, there will be an International Health Regulations Review Committee to advice on standing recommendations for the long-term management of this pandemic with the aim of reaching an international pandemic agreement.<a class="elsevierStyleCrossRef" href="#bb0030">6</a>The WHO Emergency Committee has issued seven recommendations:<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="li0005">•Sustain national capacity gains and prepare for future public health events to avoid the occurrence of a cycle of panic and neglect by updating respiratory pathogen pandemic preparedness plans incorporating learnings from national and sub-national aftermath reviews.</li><li class="elsevierStyleListItem" id="li0010">•Integrate COVID-19 vaccines into life-course vaccination programs and maintain efforts to increase COVID-19 vaccination coverage for all people in the high-priority groups with WHO recommended vaccines and continue to actively address vaccine acceptance.<a class="elsevierStyleCrossRef" href="#bb0035">7</a></li><li class="elsevierStyleListItem" id="li0015">•Join information from diverse respiratory pathogen surveillance data sources to allow for a comprehensive situational awareness.</li><li class="elsevierStyleListItem" id="li0020">•Prepare for medical countermeasures, such as vaccines and drugs, to be authorized within national frameworks to ensure long-term supply and strengthen their regulatory authorities to support long-term authorization and use of vaccines, diagnostics, and therapeutics.</li><li class="elsevierStyleListItem" id="li0025">•Work at the community level to build strong and inclusive community risk communications and engagement to manage infodemics.</li><li class="elsevierStyleListItem" id="li0030">•Continue to lift COVID-19 international travel-related health measures based on risk assessments, without requiring any proof of vaccination against COVID-19 as a prerequisite for international travel.</li><li class="elsevierStyleListItem" id="li0035">•Continue to support research to improve vaccines that reduce transmission and have broad applicability; to understand the full spectrum, incidence and impact of post COVID-19 condition and the evolution of SARS-COV-2 in immunocompromised populations; and to develop relevant integrated care pathways.</li></ul>As countries adjust their emergency response, accepting and including COVID-19-related actions into integrated respiratory disease management, there is an opportunity to strengthen the public health foundation for future epidemic and pandemic response effort. The tools and the technologies to be prepared for pandemics, to detect and respond to them earlier and this mitigate their impact are available and must be placed in practice to avoid future pandemics to become as deadly as this one has been.Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies continues to be a public health priority during the transition from the emergency phase of the COVID-19 response to routine public health practice. At the beginning in 2020, the response to the COVID-19 pandemic evidenced the need for improvements in processing and reporting public health surveillance data. In 2023, as part of the transition of COVID-19 from emergency to routine public health program activities recommended, countries should have established a sustainable and integrated surveillance strategy that monitors SARS-CoV-2 as well as other circulating respiratory viruses and prevention measures, including vaccination, to provide timely and comprehensive situational awareness.<a class="elsevierStyleCrossRef" href="#bb0040">8</a>As the COVID-19 pandemic enters its fourth year, surveillance has declined dramatically. At this moment, the 2022 Global strategic Preparedness and Response Plan (SPRP)<a class="elsevierStyleCrossRef" href="#bb0045">9</a> comes now to it's fourth edition and gives support to countries as they are working to transition their critical emergency response activities to longer-term sustained COVID-19 disease prevention, control and management.<a class="elsevierStyleCrossRef" href="#bb0025">5</a>In conclusion, the pandemic is not over and will probably not be over until a new pandemic comes along. All efforts must be set on achieving implementation and fulfillment of the stated WHO recommendations to strive for a minimal disruption of the world's population, especially those at higher risk of severe disease." 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Official journal of the Asociación Española de Vacunología (AEV) Vacunas is a peer-reviewed journal supported by an advisory board of experts in the field of vaccinology. The aim of the journal is to contribute to the dissemination of the scientific advances made in the area of basic and applied research in the field of vaccine-preventable diseases in humans. It places special emphasis on aspects associated with planning and evaluation (epidemiology of vaccine-preventable diseases, development of vaccination programs, evaluation of the efficacy, effectiveness and efficiency of vaccinations). Vacunas publishes, in Spanish and in English, Editorials, Original Articles, Special Articles, Reviews, Strategies and Vaccination Programs. There are also sections on Literature Reviews, News and on Congresses associated with vaccinations. The peer review process is done anonymously by reviewers with expertise in the area of knowledge of each manuscript as well as experts in methodology or statistics, as determined by the Editorial board, which works towards maintaining an efficient editorial process in order for the manuscripts to be published as soon as possible.

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Vol. 24. Issue 3.

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