WHO declares end to COVID-19’s emergency phase

10 May 2023

The pandemic has been on a “downward trend”, but the risk of new variants remains, says WHO director-general.

Mariana Lenharo

After 1,191 days, the WHO has declared an end to COVID-19’s public-health-emergency phase. Credit: Xavierarnau/Getty

The World Health Organization (WHO) announced on Friday that COVID-19 is no longer a public health emergency of international concern (PHEIC). The WHO director-general, Tedros Adhanom Ghebreyesus, made the decision following a recommendation by the organization’s COVID-19 emergency committee. During a meeting on Thursday, the committee highlighted the decreasing numbers of 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 next day, Tedros emphasized that COVID-19 remains a global health threat and that the new status doesn’t mean that countries can let down their guard. “It is time for countries to transition from emergency mode to managing COVID-19 alongside other infectious diseases,” he said.

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, [a PHEIC is] signalling to all countries that they need to prepare,” 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 COVID-19 PHEIC was established, countries have reported almost seven million deaths to the WHO. But the pandemic’s true death toll could be two to three times higher, according to estimates from the WHO and others.
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 is no longer an emergency, but it will be around for a long time.

Although he says the decision was pragmatic and reasonable, he worries about the effects on resources and the availability of diagnostic tests, vaccinations and treatments.

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 of an impact, given that many countries have already been relaxing 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, has announced that its COVID-19 health emergency will end on 11 May. That means that some disease monitoring and surveillance will cease and some US residents could lose access to free COVID-19 testing, vaccines and treatment. “It will worsen the inequity in the access to diagnostics and treatments, and that’s my concern,” Karim says.

The path forward
In his statement, Tedros said he has decided to establish a review committee to develop long-term recommendations for countries on how to manage COVID-19. 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.

doi: https://doi.org/10.1038/d41586-023-01559-z