The WHO Director-Common has the pleasure of transmitting the Report of the fourteenth assembly of the Worldwide Well being Rules (2005) (IHR) Emergency Committee relating to the coronavirus 2019 illness (COVID-19) pandemic, held on Friday 27 January 2023, from 14:00 to 17:00 CET.

The WHO Director-Common concurs with the recommendation provided by the Committee relating to the continued COVID-19 pandemic and determines that the occasion continues to represent a public well being emergency of worldwide concern (PHEIC). The Director-Common acknowledges the Committee’s views that the COVID-19 pandemic might be at a transition level and appreciates the recommendation of the Committee to navigate this transition rigorously and mitigate the potential destructive penalties.

The WHO Director-Common thought-about the recommendation supplied by the Committee relating to the proposed Short-term Suggestions. The set of Short-term Suggestions issued by the WHO Director-Common is offered on the finish of this assertion.

The WHO Director-Common expresses his honest gratitude to the Chair and Members of the Committee, in addition to to the Committee’s Advisors.

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Proceedings of the assembly

The WHO Director-Common, Dr Tedros Adhanom Ghebreyesus, welcomed Members and Advisors of the Emergency Committee, who have been convened by videoconference. He famous that this week marks the three-year anniversary of the dedication of the COVID-19 PHEIC in January 2020. Whereas the world is in a greater place than it was in the course of the peak of the Omicron transmission one 12 months in the past, greater than 170 000 COVID-19-related deaths have been reported globally inside the final eight weeks. As well as, surveillance and genetic sequencing have declined globally, making it harder to trace identified variants and detect new ones. Well being methods are at present combating COVID-19 and caring for sufferers with influenza and respiratory syncytial virus (RSV), well being workforce shortages, and fatigued well being employees. Vaccines, therapeutics, and diagnostics have been and stay vital in stopping extreme illness, saving lives and taking the strain off well being methods and well being employees globally. But, the COVID-19 response stays hobbled in too many international locations unable to supply these instruments to the populations most in want, older individuals and well being employees. He thanked the Chair, Members, and Advisors of the Committee for his or her work.

The Workplace of Authorized Counsel’s consultant briefed the Committee Members and Advisors on their roles, duties, and mandate underneath the related articles of the IHR. The Ethics Officer from the Division of Compliance, Threat Administration, and Ethics reminded Members and Advisers of their responsibility of confidentiality as to the assembly discussions and the work of the Committee, in addition to their particular person duty to open up to WHO in a well timed method any pursuits of a private, skilled, monetary, mental or industrial nature that will give rise to a perceived or direct battle of curiosity. No conflicts of curiosity for the attending Members and Advisors have been recognized. 

The assembly was handed over to the Chair of the Emergency Committee, Professor Didier Houssin, who launched the targets of the assembly: to supply views to the WHO Director-Common on whether or not the COVID-19 pandemic continues to represent a PHEIC, and to evaluation non permanent suggestions to States Events. 

The WHO Secretariat offered a worldwide overview of the present standing of the COVID-19 pandemic. The current fast danger evaluation continues to characterize the worldwide danger of COVID-19 to human well being and its ongoing transmission as excessive. The WHO Secretariat offered on the next: international COVID-19 epidemiological scenario; at present circulating SARS-CoV-2 variants of concern, together with descendent lineages of those variants; unexpectedly early seasonal return of influenza and RSV in some areas, which is burdening some already overstressed well being methods; standing of worldwide vaccination and hybrid immunity; and new travel-related well being measures, together with testing and vaccination necessities, applied in response to the current wave of COVID-19 instances after coverage adjustments.

The WHO Secretariat expressed concern concerning the continued virus evolution within the context of unchecked circulation of SARS-CoV-2 and the substantial lower in Member States’ reporting of knowledge associated to COVID-19 morbidity, mortality, hospitalization and sequencing, and reiterated the significance of well timed information sharing to information the continued pandemic response.

WHO continues to work intently with international locations on all points of the COVID-19 response, together with for strengthening the administration of COVID-19 inside longer-term illness management packages. The WHO Secretariat particularly highlighted its help to States Events to: preserve a number of element surveillance methods;  implement sentinel surveillance utilizing a coordinated international method to characterize identified and rising variants; strengthen COVID-19 scientific care pathways; present common updates to the COVID-19 tips; improve entry to therapeutics, vaccines and diagnostics; and proceed to conduct Unity research which offer helpful details about seroprevalence globally.

WHO is urging international locations: to stay vigilant and proceed reporting surveillance and genomic sequencing information; to advocate appropriately focused risk-based public well being and social measures (PHSM) the place crucial; to vaccinate populations most in danger to attenuate extreme illness and deaths; and to conduct common danger communication, answering inhabitants considerations and fascinating communities to enhance the understanding and implementation of countermeasures.

The Committee was knowledgeable that, globally, 13.1 billion doses of COVID-19 vaccines have been administered, with 89% of well being employees and 81% of older adults (over 60 years) having accomplished the first collection. Important progress has additionally been made in: growing efficient medical countermeasures; constructing international capability for genomic sequencing and genomic epidemiology; and in understanding methods to handle the infodemic within the new informational eco-system together with social media platforms.

Deliberative Session

The Committee thought-about the successes and challenges all through the PHEIC. The Committee acknowledged the work of WHO, Member States and companions, in attaining substantial international progress over the past three years.

But, Committee Members expressed concern concerning the ongoing danger posed by COVID-19, with a nonetheless excessive variety of deaths in comparison with different respiratory infectious ailments, the inadequate vaccine uptake in low- and middle-income international locations, in addition to within the highest-risk teams globally, and the uncertainty related to rising variants. They acknowledged that pandemic fatigue and decreased public notion of danger have led to drastically decreased use of public well being and social measures, reminiscent of masks and social distancing. Vaccine hesitancy and the persevering with unfold of misinformation proceed to be further hurdles to the implementation of essential public well being interventions. On the identical time, the long-term systemic sequelae of post-COVID situation and the elevated danger of post-infection cardiovascular and metabolic illness will probably have critical destructive on-going impression on inhabitants, and care pathways for such sufferers are restricted or not out there in lots of international locations.

The Committee acknowledged that, whereas the Omicron sub-lineages at present circulating globally are extremely transmissible, there was a decoupling between an infection and extreme illness when in comparison with earlier variants of concern. Nonetheless, the virus retains a capability to evolve into new variants with unpredictable traits. The Committee expressed a necessity for improved surveillance and reporting on hospitalizations, intensive care unit admissions, and deaths to higher perceive the present impression on well being methods and to appropriately characterize the scientific options of COVID-19 and publish COVID-19 situation.

Persistent well being workforce shortages and fatigue and competing priorities, together with different illness outbreaks, proceed to stretch well being methods in lots of international locations. The Committee emphasised the significance of sustaining capacities developed in the course of the COVID-19 response and persevering with to strengthen well being system resilience.

Standing of the PHEIC

The Committee agreed that COVID-19 stays a harmful infectious illness with the capability to trigger substantial harm to well being and well being methods. The Committee mentioned whether or not the continuation of a PHEIC is required to take care of international consideration to COVID-19, the potential destructive penalties that would come up if the PHEIC was terminated, and methods to transition in a protected method.

The Committee acknowledged that the COVID-19 pandemic could also be approaching an inflexion level. Reaching greater ranges of inhabitants immunity globally, both by means of an infection and/or vaccination, could restrict the impression of SARS-CoV-2 on morbidity and mortality, however there may be little doubt that this virus will stay a completely established pathogen in people and animals for the foreseeable future. As such, long-term public well being motion is critically wanted. Whereas eliminating this virus from human and animal reservoirs is extremely unlikely, mitigation of its devastating impression on morbidity and mortality is achievable and will proceed to be a prioritized purpose.

Shifting ahead previous the PHEIC requires a centered dedication of WHO, its Member States and worldwide organizations to growing and implementing sustainable, systematic, long-term prevention, surveillance, and management motion plans. WHO’s steerage, developed with help from related technical and advisory teams, ought to be constant, and will help States Events in taking actions and managing the implications of this transition.

The Committee, due to this fact, really helpful that WHO, in session with companions and stakeholders, ought to develop a proposal for different mechanisms to take care of the worldwide and nationwide concentrate on COVID-19 after the PHEIC is terminated, together with if wanted a doable Assessment Committee to advise on the issuance of standing suggestions underneath the IHR.

The Committee additionally requested the WHO Secretariat to supply an evaluation relating to the regulatory implications for growing and authorising vaccines, diagnostics, and therapeutics if the PHEIC have been to be terminated within the coming months.

The Committee additionally inspired WHO to evaluate and, if crucial, to speed up the mixing of COVID-19 surveillance into the World Influenza Surveillance and Response System.

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Short-term Suggestions issued by the WHO Director-Common to all States Events

1. Preserve momentum for COVID-19 vaccination to attain 100% protection of high-priority teams guided by the evolving SAGE suggestions on using booster doses. States Events ought to plan for integration of COVID-19 vaccination into a part of life-course immunization programmes. Common information assortment and reporting on vaccine protection ought to embrace each main and booster doses. (World COVID-19 Vaccination Technique in a Altering World: July 2022 replace; Up to date WHO SAGE Roadmap for prioritizing makes use of of COVID-19 vaccines January 2023; Interim assertion on using further booster doses of Emergency Use Listed mRNA vaccines towards COVID-19; Good follow assertion on using variant-containing COVID-19 vaccines; Behavioural and social drivers of vaccination: instruments and sensible steerage for attaining excessive uptake.)
2. Enhance reporting of SARS-CoV-2 surveillance information to WHO. Higher information are wanted to: detect, assess, and monitor rising variants; establish vital adjustments to COVID-19 epidemiology; and perceive the burden of COVID-19 in all areas. States Events are really helpful to make use of an built-in method to respiratory infectious illness surveillance that leverages the World Influenza Surveillance and Response system. Surveillance ought to incorporate info from consultant sentinel populations, event-based surveillance, human wastewater surveillance, sero-surveillance, and animal-human-environmental surveillance. WHO ought to proceed to work with Member States to make sure satisfactory capability and protection of COVID-19 surveillance are in place to recognise rapidly any vital adjustments within the virus and/or its epidemiology and scientific impression together with hospitalization, in order that WHO can set off acceptable international alerting as crucial. ( Public well being surveillance for COVID-19 )
3. Improve uptake and guarantee long-term availability of medical countermeasures. States Events ought to improve entry to COVID-19 vaccines, diagnostics and therapeutics, and take into account getting ready for these medical countermeasures to be licensed exterior of  Emergency Use Itemizing procedures and inside regular nationwide regulatory frameworks. (Therapeutics and COVID-19: residing guideline; COVID-19 Medical Care Pathway)
4. Preserve robust nationwide response capability and put together for future occasions to keep away from the prevalence of a panic-neglect cycle. States Events ought to take into account methods to strengthen nation readiness to reply to outbreaks together with consideration to well being workforce capability, an infection prevention and management, and financing for respiratory and non-respiratory pathogen preparedness and response. (WHO COVID-19 coverage briefs; Strengthening pandemic preparedness planning for respiratory pathogens: coverage temporary)
5. Proceed working with communities and their leaders to deal with the infodemic and to successfully implement risk-based public well being and social measures (PHSM). Threat communication and neighborhood engagement ought to be tailored to native contexts and sort out mis- and dis-information that erodes belief in medical countermeasures and PHSM. States Events ought to strengthen the general public, media, and communities’ understanding of the evolving science to encourage evidence-informed motion and insurance policies. States Events ought to proceed to watch particular person and public response to the implementation of PHSM and the uptake and acceptability of COVID-19 vaccines, and implement measures, together with communication methods, to help acceptable utilization.  (WHO danger communications sources; Concerns for implementing and adjusting PHSM within the context of COVID-19.)
6. Proceed to regulate any remaining worldwide travel-related measures, primarily based on danger evaluation, and to not require proof of vaccination towards COVID-19 as a prerequisite for worldwide journey. (Interim place paper: issues relating to proof of COVID-19 vaccination for worldwide travellers; Coverage issues for implementing a risk-based method to worldwide journey within the context of COVID-19).
7. Proceed to help analysis for improved vaccines that scale back transmission and have broad applicability, in addition to analysis to know the total spectrum, incidence and impression of publish COVID-19 situation, and to develop related built-in care pathways.