In a move that some critics say should have happened 1 week ago, the World Health Organization (WHO) has declared the outbreak of a novel coronavirus in China a global health emergency. WHO Director-General Tedros Adhanom Ghebreyesus announced the move at a press conference on Thursday evening in Geneva. The new disease, first made public by China on 31 December 2019, has already spread to 18 countries; 7834 people have been infected and 170 of them, all in China, have died.
WHO’s emergency committee on the epidemic met in the afternoon and recommended designating the outbreak a Public Health Emergency of International Concern (PHEIC), just the sixth time WHO has used that label since the designation was introduced 15 years ago. The decision had been “almost unanimous,” Didier Houssin, chair of the emergency committee, said at the press conference.
“The main reason for this declaration is not because of what is happening in China, but because of what is happening in other countries,” Tedros said at the press conference. “Our greatest concern is the potential for the virus to spread to countries with weaker health systems and which are ill-prepared to deal with it. Let me be clear, this declaration is not a vote of no confidence in China. On the contrary, WHO continues to have confidence in China’s capacity to control the outbreak.” Tedros also outlined recommendations made by the emergency committee to control the outbreak, including accelerating the development of vaccines and drugs and combatting the spread of misinformation.
Tedros also emphasized that WHO is against limiting trade or travel between countries. “We call on all countries to implement decisions that are evidence-based,” he said. “This declaration will provide to WHO the ability to question these measures which have already been taken by some countries,” Houssin added.
Other public health experts quickly applauded WHO’s move. “I think it’s the right decision. It’s clearly of great international concern,” says Tom Inglesby, director of the Center for Health Security at the Johns Hopkins University Bloomberg School of Public Health. “Declaration of an international emergency will undoubtedly sharpen governments’ focus on protecting citizens,” infectious disease specialist Jeremy Farrar, head of the Wellcome Trust, a U.K. charity that funds biomedical and public health research, wrote in a statement.
Many of those experts were baffled last week when the emergency committee met for 2 days and remained split on the question of deciding a PHEIC, leading Tedros to put off the decision. “I think he should have declared a PHEIC then,” says Ashish Jha, who specializes on global health at the Harvard T. H. Chan School of Public Health. “But I don’t think this delay of 1 week has endangered the world in some massive way.”
Under the International Health Regulations (IHRs), a legally binding set of rules adopted in 2005, declaring a PHEIC gives WHO some additional powers over its member nations, including recommending travel restrictions that countries have to follow. WHO has little power to enforce those recommendations, however, and during the Ebola outbreak in West Africa, many countries closed their borders or restricted travel in direct contradiction of WHO recommendations.
Although the declaration does little to change the technical or logistical side of fighting an outbreak, there is also a political side to such a fight, Jha says. “A PHEIC just raises the level of political attention. And it gives more moral authority to WHO.” It can also mobilize resources to fight the outbreak, he adds.
Previous PHEICs include Ebola outbreaks in West Africa in 2014, the ongoing one in the Democratic Republic of the Congo (DRC), the pandemic flu in 2009, polio in 2014, and the Zika virus in 2016. The polio transmission and the Ebola outbreak in the DRC are still considered PHEICs by WHO.
The system itself may need an overhaul, however. At a previous press conference on Wednesday night, Tedros suggested the yes/no decision on a PHEIC needed to be changed. “The IHR now is PHEIC or no PHEIC, either green or red. I think we have to now revise that,” he said, suggesting there should be a yellow alert between the two states. “We hope that will address some of the controversies.” That idea has been discussed for years. For instance, a 2015 WHO-commissioned report on lessons learned from the West African Ebola outbreak raised the possibility of “an intermediate level that would alert and engage the wider international community at an earlier stage of a health crisis.”
Although no deaths from the novel coronavirus have been recorded outside of China, four other countries have reported human-to-human transmission of the virus: Germany, Japan, Thailand, and the United States, Tedros said on Thursday. “The only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation. We’re all in this together.”