When do we declare the Covid pandemic over?

Friday marks two years since the World Health Organization first labelled the Covid-19 outbreak a pandemic. More than 6mn deaths have been recorded globally; the true figure could be four times that. 

With the Omicron wave subsiding in some regions and around 4.4bn people fully vaccinated, many countries, including the UK, are attempting a return to normal. Thoughts are now turning to when the agency might officially de-escalate this extraordinary health crisis and signal the worst is over.

Despite the veneer of normality, we are still officially in a Public Health Emergency of International Concern (or Pheic). Unlike the “pandemic” tag, referring to worldwide spread, this declaration by WHO on January 30, 2020, carries legal heft under international health regulations. The siren is meant to spur countries to action, including surveillance and mandatory case reporting. Once declared, they are reappraised every three months, against three criteria. “If the committee decides the outbreak is no longer unusual and unexpected, no longer risking international spread and no longer requiring a co-ordinated international effort, the Pheic ends,” says Clare Wenham, researcher in global health policy at the London School of Economics.

But, as her research has shown, those criteria have been applied inconsistently in the six Pheics declared since the mechanism came into effect. A polio outbreak that was ruled as one in 2014 remains classified as such, despite most cases being concentrated in a handful of regions. Retaining a Pheic, Wenham says, “means people have to do something about it”. Lifting that status on Covid might jeopardise the ongoing immunisation drive in low-income countries; drugmakers, for example, have agreed to make antiviral pills affordable until the emergency ends. 

Record-breaking Covid surges in Hong Kong and New Zealand also render an imminent reversal unlikely. “The mortality rate in Hong Kong today is higher than it was in Peru in 2020,” says Rebecca Katz, director of the Centre for Global Health Science and Security at Georgetown University.

This relentless turnover of infections contrasts with the neatly demarcated end of the 2014-2016 Ebola emergency in West Africa. In 2016, when the last Ebola patients tested negative twice and no new cases were seen after a further 90 days, WHO lifted the 2014 Pheic. Katz speculates that if no new Covid variants arrive and vaccination levels improve, the emergency phase could be over by the end of 2022, but cautions “there’s no algorithm for this”.

Yet any reversal, whenever it comes, might not matter much to many governments. There is little systematic analysis of what materially happens in WHO member states when Pheics are declared and rescinded. It was the pandemic label given in March 2020 that prompted many countries to finally take notice, rather than the Pheic declared six weeks earlier.

As Wenham points out, Pheics sound an alarm but come without operational teeth: no special pots of money are unlocked, no crack teams of epidemiologists are deployed. Countries are not incentivised to follow health regulations nor sanctioned for breaking them. That allowed what should have been a unified struggle against Covid to splinter into national efforts, resulting in vaccine inequality and the kind of travel bans that the regulations are supposed to deter. 

Amendments to those regulations, a more binding pandemic treaty and new financing facilities are now rightly under discussion to position disease outbreaks as security and economic threats and pull other institutions into the response. But, as we lurch from pandemic to putative war, the global co-operation required to end this emergency and prevent future ones seems more fragile than ever.

The writer is a science commentator