London - The World Health Organization
is considering changing the way it classifies and describes
international epidemics, amid a protracted public debate over
whether to call the outbreak of the new coronavirus a pandemic.
Officials at the Geneva-based WHO – who this week described
it as a pandemic for the frst time - are reviewing how the
health agency communicates its risk assessment of disease
outbreaks in the future, said two people familiar with the
discussions. They said that included use of the term pandemic as
well as PHEIC, which stands for public health emergency of
international concern.
Among ideas that have been discussed is whether to use a
more graded approach to capture different levels of severity,
rather than binary terminology, the two people said. That would
enable the WHO to dial up the severity of its messaging to
prompt global cooperation on issues such as funding and drug
development across the public health and scientific community,
but without causing unnecessary public alarm.
WHO Director General Tedros Adhanom Ghebreyesus has publicly
signalled support for a more nuanced approach, saying the
current system of declaring a public health emergency is too
blunt.
"It's either red or green," Tedros said during a Jan. 29
conference with news media. "I think we have to now revise that.
You cannot have just yes or no. There could be some intermediate
situation." He suggested a yellow stage that could be “a
warning…serious enough but not really red.”
The agency’s emergency committee on the new coronavirus,
which is made up of independent experts, alluded to the internal
discussions the following day. In a Jan. 30 statement following
a meeting at which it declared a public health emergency, the
panel said it recommended that the WHO “continue to explore the
advisability of creating an intermediate level of alert” between
PHEIC or no PHEIC.
WHO spokeswoman Margaret Harris said that currently the
decision on declaring a public health emergency of international
concern, or PHEIC, is “binary.” She said the WHO’s emergency
committee on coronavirus suggested, and the director general
agreed, to meet to “review whether the existing instrument is
still fit for purpose.”
The discussion around the agency’s messaging on epidemics
comes as it seeks to coordinate the global fight against an
outbreak of infection with the newly identified coronavirus,
which emerged in December. Now known as Covid-19, it has spread
from China to more than 100 countries, killing thousands of
people with more expected to die.
While many public health experts say the WHO’s response to
this epidemic has been timely and decisive, the agency has also
drawn criticism from some commentators who say it has been too
quick to heap praise on China – a criticism Tedros has strongly
rejected, saying China’s drastic measures have slowed the virus
spread and allowed other countries to prepare. The agency also
came under intense media scrutiny in recent weeks as it
refrained from calling the infectious disease’s spread a
pandemic, even as it took grip in scores of countries around the
world.
When the WHO did on Wednesday describe Covid-19 as a
pandemic, Director General Tedros said the agency was concerned
about “the alarming levels of spread and severity” of
coronavirus. While the characterisation doesn’t trigger any
formal change in what the agency does or it recommends countries
do, some public health experts said it might prompt governments
to move more swiftly to make interventions, such as banning or
restricting public gatherings or travel.
GLOBAL HEALTH EMERGENCY
Under the WHO’s International Health Regulations, the agency
can formally declare a PHEIC (pronounced "fake"), or global
health emergency, which it did with Covid-19 on January 30. Such
declarations are made when an epidemic meets two criteria: The
outbreak poses a risk to more than one country and it requires a
coordinated international response. The formal designation
triggers various moves, including calls for increased funding
and resources, recommendations to countries aimed at preventing
or reducing cross-border spread of disease and boosting public
health measures.
The WHO has declared PHEICs on five previous occasions,
including the West Africa Ebola outbreak starting in 2014 and
the 2016 Zika virus outbreak that spread from Brazil.
In 2009, the WHO declared the outbreak of H1N1 flu a
pandemic. That move later drew criticism from some governments
that it triggered some countries to take expensive measures,
including stockpiling and prescribing anti-viral drugs and
undertaking mass vaccinations against a flu that ultimately turn
out to be milder than originally thought. The then-director
general, Dr. Margaret Chan, has defended her decision as the
“right call.”
How the WHO communicates around global epidemics was under
review even before the Covid-19 outbreak began in December,
according to the two people familiar with the discussions.
According to one of those people, the discussion was
prompted in part by last year’s outbreak of Ebola in eastern
Democratic Republic of Congo, which the WHO declared a PHEIC in
July 2019. WHO officials wanted to sound an alarm and prompt a
global response in terms of funding and vaccines, but there were
questions among some officials at the WHO and member states
about whether it was truly an international issue because the
Ebola outbreak affected only Congo and neighbouring Uganda, the
person said. They added that these questions focused discussion
on whether a graded approach might be more appropriate.
When Covid-19 began spreading beyond China, global health
officials and experts looked to the WHO to declare a PHEIC. Even
after it did so in late January, the agency faced repeated
questions from international media on whether or not the
outbreak was a pandemic.
PANDEMIC CONTROL
Some WHO chiefs have expressed concern that using the label
pandemic might signal to governments and the public that the
coronavirus outbreak had developed to a level where there was no
longer action they could take to control its spread.
That was a key part of the WHO’s message when it did
ultimately call the coronavirus as a pandemic. “We cannot say
this loudly enough, or clearly enough, or often enough: all
countries can still change the course of this pandemic. This is
the first pandemic that can be controlled,” Tedros said in a
tweet Wednesday.
WHO officials and some global health experts said the
media’s focus on the word pandemic was an unwanted distraction
for them because, unlike the PHEIC classification, it doesn’t
trigger specific responses within countries.
"There is an unhelpful alignment in people's minds between
this 'pandemic' word and some sort of major shift in approach -
but this is not the case," Mike Ryan, head of WHO's health
emergencies programme, told reporters at a March 3 briefing for
news media.
A sign of the WHO’s frustration was visible during a news
conference this week – one of around 30 hour-long briefings the
WHO has held for international media since the Covid-19 outbreak
began. A senior official who had been asked repeatedly by
journalists about whether the disease constituted a pandemic
gave a half-joking but tetchy response: "This is a word you
love, right? You just can't wait, can you?"
Some specialists agree that the external focus on the label
pandemic have been a distraction, including Lawrence Gostin, a
global health expert at Georgetown University Law School in
Washington. Gostin has been openly critical of the WHO in the
past - in particular for what he considered to be moving too
slowly to declare international emergencies over Ebola and Zika.
With the Covid-19 outbreak, however, Gostin said the WHO was
right to not describe it as a pandemic prematurely because the
word tends to generate fear.
Global health specialists say that more subtleties in how
WHO messages around epidemics could be useful, but say they
doubt it will make much practical difference.
"In the end if you move from a binary to a three or four
stage process, you'll always have these semantic arguments,"
said Jeremy Farrar, an expert in infectious disease epidemics
and director of the Wellcome Trust global health charity. "And
is there really a difference between a global epidemic and a
pandemic? And does it make a difference to what we do?” he said.
“I don't think so."