Statement on the twelfth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic – World Health Organization

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The WHO Director-General has the pleasure of transmitting the particular Report of the twelfth meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic, held on Friday, 8 July 2022, from
12: 00 to 15: 30 CEST.

The WHO Director-General concurs with the advice offered by the Committee regarding the ongoing COVID-19 pandemic and determines that the event continues to constitute a Public Health Emergency of Worldwide Concern (PHEIC).

The WHO Director-General considered the advice provided by the Committee concerning the proposed Temporary Recommendations. The set of Temporary Recommendations issued by the particular WHO Director-General is presented at the end of this statement.

The WHO Director-General is taking the opportunity to express his sincere gratitude to the Chair, and Members from the Committee, as well as to its Advisors.

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Proceedings of the meeting

On behalf associated with the WHO Director-General, the particular Executive Director of the WHO  Health Emergencies Programme, Dr Michael J.   Ryan, welcomed Members plus Advisors of the Emergency Panel, all of whom were convened by videoconference.

Dr Ryan expressed concern regarding the current global COVID-19 epidemiological situation. Cases of COVID-19 reported to THAT had increased by 30% in the last two weeks, largely driven by Omicron BA. 4, BA. 5 and other descendent lineages and the lifting
of public health and social measures (PHSM). This increase in cases was translating into pressure on health systems in a number of WHO ELSE regions. Dr Ryan highlighted additional challenges towards the ongoing COVID-19 response: recent changes in testing policies
that hinder the detection associated with cases and the monitoring of virus evolution; inequities in access to testing, sequencing, vaccines and therapeutics, including new antivirals; waning of natural and vaccine-derived protection; and the global burden of
Post COVID-19 condition.

The Ethics Officer from the Department associated with Compliance, Risk Management, plus Ethics briefed Members and Advisers on their roles and responsibilities. Members plus Advisors were also reminded of their duty of confidentiality as to the meeting discussions
and the work of the particular Committee, as well as their individual responsibility in order to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict
of interest. Each Member plus Advisor who was present was surveyed. No conflicts of interest were identified.

The Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities and the mandate of the Emergency Committee under the particular relevant articles from the IHR.

The meeting was handed over to the Seat of the Emergency Committee concerning the COVID-19 pandemic, Professor Didier Houssin. The Chair introduced the objectives of the meeting: to provide views to the WHO Director-General on whether the COVID-19 outbreak
continues to  constitute a PHEIC, and to review  temporary recommendations  in order to States Parties.  

The particular WHO Secretariat presented the global overview of current status of the COVID-19 pandemic, and highlighted a number of challenges to the ongoing response. The presentation focused on: the global COVID-19 epidemiological situation; the evolution of the particular
virus and the impact of SARS-CoV-2 variants of concern; an update on international travel-related measures; the present status of COVID-19 vaccination and progress towards WHICH vaccination targets; and the 2022 WHO Strategic preparedness, readiness
and response plan.

Deliberative session

The Committee discussed the following issues: the particular impact of SARS-CoV-2 virus evolution on the public health response and capacities of health services; progress towards increasing COVID-19 vaccination coverage; changes in screening and surveillance strategies;
societal and political risk perception and community engagement; equity and access to countermeasures, vaccines and therapeutics; and maintaining political engagement while balancing the need in order to respond to other general public health priorities and emergencies.
The Committee discussed that will SARS-CoV-2 virus had not yet established its ecological niche and that the implications of a pandemic caused by a novel respiratory virus may not be fully understood. Consequently, given the current shape plus unpredictable
dynamics from the COVID-19 pandemic, the Committee emphasized the need to reduce the transmission of SARS-CoV-2 virus. This requires the responsible, consistent, and continued use of individual-level protective measures, to the benefit associated with communities
as a whole; as well as the particular continued adjustments of community-wide PHSM, to overcome the “all or nothing” binary approaches.

The Committee expressed concern as to the continuing changes observed in States Parties with respect to steep reductions in tests, resulting in reduced coverage and quality of surveillance as fewer cases are being detected and reported in order to WHO; and fewer
genomic sequences being submitted to open access platforms – resulting in a lack of representativeness of genomic sequences from all WHO regions. This impedes assessments of currently circulating and emerging variants associated with the virus, including
the particular generation and analysis of phenotypic data. The above is translating into the increasing inability to interpret trends in transmission, and consequently to properly inform the adjustments of PHSM.

The epidemiology of SARS-CoV-2 virus infection remains unpredictable as the virus continues to evolve, through sustained transmission within the human population and in domestic, farmed, and wild animals in which the virus was newly introduced.

The particular Committee noted that both the trajectory of viral evolution and the characteristics of emerging variants of the virus remain uncertain and unpredictable, and, in the particular absence of the adoption associated with PHSM aiming at reducing transmission, the resulting selective
pressure on the virus increases the probability of new, fitter variants emerging, with different degrees of virulence, transmissibility, plus immune escape potential.

For these reasons, the Committee highlighted the need for all States Parties to continue to apply PHSM proportionate to their epidemiological situation, stressing the continued use of effective, individual-level protective steps to reduce transmission.
The Committee acknowledged the continuous challenges faced by Says Parties in adjusting and implementing PHSM. The Committee acknowledged WHO’s advice in order to States Parties to regularly assess the epidemiological scenario at sub-national levels
plus adjust PHSM proportionately. PHSM should be adjusted based on estimates of disease prevalence and population protection from infection and vaccination, as well as the capacities from the local health system (already challenged, inter alia, by staff
shortages due to COVID-19 related burn-out).

The Committee highlighted the particular need to improve monitoring, by broadening and developing an array of approaches and tools aiming at achieving global situational population- based and geographic representativeness. These include, but are not limited to,
the integration of self-testing results and sentinel surveillance approaches into national and worldwide surveillance schemes, and aggregate sampling strategies with Nucleic Acid Amplification Test-based equipment and detailed deep genome sequence probing.
Novel security approaches would enhance better assessment of trends in epidemiology of infection, illness, and viral evolution, because well as trends within health system capacity, and support agility and timely adjustments of PHSM. The particular Committee acknowledged
the need to expedite integration associated with COVID-19 surveillance into routine systems, for instance simply by integrating COVID-19 surveillance  with the surveillance of other respiratory system pathogens; and recognized the potential value of supplementing surveillance
with wastewater surveillance. In addition, access to timely plus accurate testing, with linkage to clinical care and therapeutics, needs to be maintained.

The Committee recognised the continued work of WHO plus partners in increasing vaccination coverage in all six WHO ALSO regions, with focus in achieving the highest possible vaccination protection among persons at highest risk of severe condition outcomes and among
persons at highest risk of exposure;   as well as assessing and addressing barriers to vaccine uptake. However, given the persistent vaccine inequities, the Panel reinforced the need for ensuring that the highest priority groups are vaccinated
within every country, with the primary series and booster dose, in accordance with WHO global vaccination strategy and the updated WHO SAGE Roadmap for prioritizing uses associated with COVID-19 vaccines .   The Committee expressed issue over the lack of data shared with WHO upon vaccination coverage in the particular high priority groups for 30% of the countries. The Committee
acknowledged the disruption the pandemic continues to have on routine immunization activities, which is resulting in outbreaks of vaccine-preventable diseases in areas associated with low coverage.

The Committee outlined that immediate efforts are warranted to promote access for Low and Middle Income Countries to therapeutics that reduce disease severity in both ambulant and hospitalised patients. The Committee warned that the lack of equitable
access that occurred with vaccines should not be repeated along with therapeutics. The Committee also highlighted the continued require for further research plus development for COVID-19 in the areas of epidemiology and variants, diagnostics, clinical care
including care for Post COVID-19 condition, and additional COVID-19 vaccines.

Given the general public’s perception that the pandemic may be over, the particular Committee also highlighted the ongoing challenges in communicating, particularly to communities that will continue to experience high levels of transmission, that the particular mitigation
of the effect of the ongoing COVID-19 pandemic, in the immediate and longer terms, depends on the use of PHSM. The Committee emphasised the importance of using learning from the last two plus a half years to nuance the implementation associated with PHSM in individual
areas. The Committee acknowledged that any risk communication and community engagement effort ought to hinge on  consistent plus synchronized political will, guidelines, and a concert of community influencers to shift the course of risk perception.

Status of the Public Health Emergency of International Concern

The Panel recognized an overall decoupling of incident cases through severe disease, deaths, and pressure on health systems in the context of increased population immunity.

However, the Committee unanimously agreed that the COVID-19 outbreak still meets the criteria of an extraordinary event that continues to adversely impact the particular health of the world’s population, and that the emergence and international spread of new
SARS-CoV-2 variants may present an even greater health impact.

The Committee explicitly indicated  the following reasons underpinning their advice in order to the WHO Director-General regarding the event continuing to make up a PHEIC.

Firstly, the particular recent increase in the growth rate of cases in many States Parties in different WHO regions.

Secondly, the particular continuing and substantial evolution of SARS-CoV-2 virus, which, while inherent to almost all viruses, is expected to continue in an unpredictable manner. Yet the ability to assess the impact associated with variants on transmission, disease characteristics,
or countermeasures, including diagnostics, therapeutics and vaccines, is becoming increasingly difficult as a result of the inadequacy of current surveillance, including the reductions in testing and genomic sequencing. Additionally, there are usually uncertainties
surrounding the level of readiness of already overburdened health systems, across all WHO regions, in order to respond to future COVID-19 pandemic waves.

Thirdly, open public health and health planning tools to reduce transmission and disease burden (including hospitalisations and admissions to intensive care units associated with severe cases, and the impact of post COVID-19 condition) are not being implemented in proportion
in order to local transmission levels or even health system capacities.

Finally, there are inadequacies in risk communication and community engagement related to the advantages of the particular implementation or adjustment of PHSM, as well since a disconnect in the perception of risk posed by COVID-19 between scientific communities, political
leaders plus the general public.

For these reasons, continued coordination associated with the international response is necessary to reconsider approaches allowing for the accurate and reliable monitoring of the development from the COVID-19 pandemic and triggering of adjustments to PHSM. Coordination
is furthermore still necessary to intensify plus sustain development and research efforts related to effective and equitably available countermeasures plus to develop further danger communication and community wedding approaches.

The Committee considered the particular Temporary Recommendations proposed by the WHO Secretariat and provided its advice.

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Short-term Recommendations issued by the WHO Director-General to just about all States Parties

  1. MODIFIED : Strengthen national response to the COVID-19 pandemic simply by updating national preparedness plus response plans in line with the priorities and potential scenarios outlined within the 2022 WHO Strategic Preparedness,
    Readiness and Response Plan. States Parties need to regularly conduct assessments (including e. g. intra action and after action reviews) to inform current plus future response, readiness and preparedness efforts, so that will future challenges are rapidly
    identified and managed, which includes with tools and methods different from those adopted in the context of the particular current shape of the pandemic. ( WHOM Strategic preparedness, readiness plus response plan to end the global COVID-19 emergency within 2022 )
  2. ALTERED : Address risk communications and local community engagement challenges and the particular need to address divergent perceptions in risk between scientific communities, political leaders and the general community . Proactively
    counter misinformation and disinformation, and include communities in decision making. To re-build trust and to address pandemic fatigue and risk perceptions, Declares Parties should explain clearly and transparently changes in the implementation
    of PHSM, as well as the uncertainties related to the particular evolution of the virus plus related potential scenarios.   Risk communication and neighborhood engagement efforts can only be effective in altering the course of present individual behaviours
    if underpinned by consistent strategies, plans as well as the political will in order to manage the COVID-19 pandemic, and concurrent public wellness risks, within and among States Parties. ( WHO risk communications resources )
  3. MODIFIED : Achieve national COVID-19 vaccination targets within accordance with global WHO HAVE vaccination targets   and the updated WHO SAGE Roadmap with regard to prioritizing uses of COVID-19 vaccines. Claims Parties should determine and close the
    vaccination gap among high-risk populations to achieve the highest possible vaccination coverage among persons at highest risk of severe disease outcomes and amongst persons at highest risk of exposure, health workers, the elderly and other concern
    groups. This includes a primary series plus booster dose as per EXACTLY WHO SAGE recommendations. In addition , States Parties must always support global equitable entry to vaccines to achieve national insurance coverage targets on the way to the WHO global
    COVID-19 vaccination targets, which usually includes 70% population insurance in every State Party for further disease reduction and protection against future risks. States Parties with less than 20% vaccination coverage should develop strategies and/or
    receive assistance to improve their status. States Parties need to ensure that program immunization activities continue plus may consider integrating COVID-19 vaccination into routine immunization services, such as the co-administration of COVID-19
    vaccine and an inactivated seasonal influenza vaccine, as warranted. ( WHO SAGE Prioritization Map ; Interim statement around the use associated with additional booster doses of Emergency Use Listed mRNA vaccines against COVID-19 ; Coadministration associated with seasonal inactivated influenza and COVID-19 vaccines
  4. MODIFIED :. Continue to promote the use of effective, individual-level protective actions to reduce transmission (e. g. wearing of well-fitted masks, distancing, staying home when sick, frequent hand washing, avoiding
    closed spaces with poor ventilation, crowded places, improving and investing in ventilation of indoor spaces) in order to reduce tranny and slow down virus-like evolution. States Parties should be prepared to scale up PHSM rapidly in response
    to changes in the virus and the population immunity, as COVID-19 continues to have the potential to stretch the capacity of public health plus health services, with hospitalizations, intensive care admissions, fatalities, management from the Post
    COVID-19 condition, and thus compromise the particular health system’s capacity not really only to deliver COVID-19 related care, but also the care for other acute and chronic conditions ( Considerations for implementing and adjusting PHSM within the context of COVID-19 )
  5. MODIFIED : Take a risk-based approach to mass gathering events by evaluating, mitigating, and communicating risks . Recognizing that there are different drivers and danger tolerance for mass gatherings, it is critical
    to consider the epidemiological context (including the prevalence of variations of concern and the intensity of transmission), monitoring, contact tracing and assessment capacity, as well as adherence to PHSM in order to reduce transmission risk of SARS-CoV-2
    (e. g. request attendees wear well-fitted masks, provide outdoor spaces where attendees can eat and drink, reduce crowding, improve indoor ventilation) when conducting this risk assessment plus planning events, in collection with WHO guidance. ( WHO mass collecting COVID-19 risk assessment tool: generic events )
  6. MODIFIED : Adjust COVID-19 surveillance   to focus on the burden of COVID-19, its impact on health and public health services; and prepare for sustainable integration with other surveillance systems. Says Parties
    should collect plus publicly share indicators to monitor the burden of COVID-19 (e. g. new hospitalizations, admissions to intensive treatment units, deaths, and Article COVID-19 condition). States Events should integrate respiratory illness surveillance,
    for instance by leveraging and enhancing the Global Influenza Surveillance and Reaction System (GISRS). States Celebrations should be encouraged in order to 1) maintain representative examining strategies; 2) focus upon early warning and trend monitoring, including
    through the particular progressive development and introduction of environmental surveillance schemes (e. g., wastewater surveillance); 3) monitor severity in vulnerable groups; and 4) enhance laboratory surveillance to detect, track and characterize potential
    new variants and monitor the evolution associated with SARS-COV-2. ( Guidance for surveillance of SARS-CoV-2 variants ; WHO global genomic security strategy for pathogens with pandemic and epidemic possible 2022–2032 )
  7. REVISED : Make available essential health, social, and education services . States Parties should enhance access to health, including through the restoration of health services at all amounts and strengthening of interpersonal
    systems to cope with the impacts of the pandemic, especially on children, young adults, plus individuals with Post COVID-19 condition. Within this context, States Parties should maintain educational services by keeping schools fully open along with in-person
    learning. In addition, essential health services, which includes COVID-19 vaccination, should become provided to migrants and other vulnerable populations as a priority. ( Building health systems resilience regarding universal health coverage plus health security during the COVID-19 pandemic and beyond: WHO position paper ;
    The State of the particular Global Education Crisis | UNICEF ; Clinical management of COVID-19: Living guideline )
  8. MODIFIED : Continue to adjust worldwide travel-related measures , based on risk assessments. The execution of travel measures (such as vaccination, screening, including via testing, isolation/quarantine of
    travelers) should be in proportion (based on risk assessments) and should avoid placing the financial burden on global travelers, in accordance with Article 40 of the IHR. ( Policy considerations for implementing a risk-based approach to international travel in the context associated with COVID-19 )
  9. EXTENDED : Do NOT require proof of vaccination against COVID-19 intended for international travel as the just pathway or condition permitting international travel . Declares Parties should consider a risk-based approach to the particular
    facilitation of international journey. ( Interim position paper: considerations regarding proof of COVID-19 vaccination to get international travelers ; Policy considerations pertaining to implementing a risk-based approach to international travel within the context of COVID-19 )
  10. MODIFIED : Support well-timed uptake of accurate and timely SARS-CoV-2 testing, linked to WHO recommended therapeutics . States Parties should provide access to COVID-19 treatments for vulnerable populations, particularly
    immunosuppressed people,   plus improve access to specific early treatments for patients at higher risk for serious disease outcomes. Local production and technology transfer associated to vaccines, other therapeutics and diagnostics should be encouraged
    and supported as increased production capacity can contribute to global equitable access to therapeutics. ( Therapeutics and COVID-19: living guideline ; COVID-19 Clinical Care Pathway )
  11. PROLONGED : Conduct epidemiological investigations of SARS-CoV-2 transmission at the human-animal interface and targeted surveillance on potential animal hosts and reservoirs . Investigations at the human animal interface
    should use an One Health approach and involve all relevant stakeholders, which includes national veterinary services, wildlife authorities, public health services, and the environment sector. To facilitate international transparency, and in line along with
    international reporting obligations, findings from joint investigations must be reported publicly. ( Statement from the Advisory Group on SARS-CoV-2 Evolution in Animals ;
    Joint statement on the prioritization of monitoring SARS-CoV-2 infection in wildlife and preventing the formation associated with animal reservoirs )
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