The World Health Organization (WHO) announced Friday that COVID-19 is no longer a public health emergency of international concern, or PHEIC. WHO’s director-general, Tedros Adhanom Ghebreyesus, made the decision following a recommendation by the organization’s COVID-19 emergency committee. During a meeting this Thursday, the committee highlighted the decreasing trend in deaths and hospitalizations, and the high levels of population immunity against SARS-CoV-2 as reasons for ending the PHEIC.

During a press conference the following day, Tedros emphasised that COVID-19 remains a global health threat and said that the new status doesn’t mean that countries should let down their guard. “It is time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases.”

The announcement didn’t come as a surprise. After the emergency committee’s last meeting, in late January, Tedros acknowledged that the pandemic was probably at a transition point.

“This is not a snap decision. It is a decision that has been considered carefully for some time, planned for, and made on the basis of a careful analysis of the data,” he said during the press conference.

Practical impacts

A PHEIC – defined by the WHO as an extraordinary event that constitutes a public health risk to other countries through the international spread of disease – is the highest level of international public health alarm. The COVID-19 PHEIC was declared on 30 January 2020. In practice, this decision compelled countries to start reporting cases to the WHO to create worldwide surveillance. “Importantly, it’s signaling to all countries that they need to prepare for it,” says epidemiologist Salim Abdool Karim, the director of the Centre for the AIDS Programme of Research in South Africa, in Durban.

In the three years, three months and five days that have passed since the PHEIC was first established, countries reported 7 million deaths to the WHO. Estimates from the WHO and others as to the pandemic’s true death toll are two to three times higher.

There are no hard and fast rules to determine when a PHEIC is over, says Karim. “We are still very much in a pandemic, we are just in a different stage in which we are no longer seeing large numbers of deaths and pressure on hospitals,” he adds. For Karim, the end of the PHEIC is a recognition that SARS-CoV-2 will be around for a long time.

But although he says the decision was pragmatic and reasonable, he worries what it will mean in terms of resources and the availability of diagnostic tests, vaccination and treatment.

Epidemiologist Jennifer Nuzzo, the director of the Pandemic Center at Brown University, in Providence, Rhode Island, says it is unclear whether this decision will have much practical impact given that many countries have already been relaxing their measures to combat COVID-19. “Political attention to the pandemic was lost long before this decision, unfortunately,” Nuzzo says. “Even while COVID remains a top cause of death, governments have decided to put their energies elsewhere.”

Nuzzo says it’s important to distinguish between the end of the PHEIC and the decision by individual countries to end their public health emergencies. The United States, for example, announced that its COVID-19 health emergency will end on 11 May. That means that US residents will lose access to free COVID-19 testing, vaccines and treatment. “So, it will worsen the inequity in the access to diagnostics treatments and that’s my concern,” Karim says.

The Path Forward

In his statement, Tedros said he also decided to establish a review committee to develop long-term recommendations for countries on how to manage COVID-19 going forward. On Wednesday, the WHO published an updated version of their strategic preparedness and response plan for COVID-19, outlining actions that countries should take in the next two years.

“What is most urgent now is to make sure that countries don’t turn their back on trying to learn the lessons of COVID and bolster their preparedness for future pandemics,” Nuzzo says.

This article is reproduced with permission and was first published on May 5, 2023.