January 24, 2020

expert reaction to WHO decision not to declare the China coronavirus outbreak a PHEIC (Public Health Emergency of International Concern)

Last night the World Health Organisation (WHO) emergency committee re convened and decided not to declare the China coronavirus outbreak a PHEIC (Public Health Emergency of International Concern).

Dr Stephen Griffin, Associate Professor, University of Leeds, said: 

“I’m personally surprised that a PHEIC hasn’t been called given that the R0 appears similar to SARS, we have 4th generation spread and the proportion of severe cases appears high. However, it is often difficult to understand the precise criteria by which one of these is implemented – it sounds as though the committee had some differences of opinion! I suppose there is a track record of relative caution in these decisions- look at the delay for  both of the large Ebola virus outbreaks. My hope is that this is not a decision that we might come to regret.”

Professor Tom Solomon,Director of the UK’s Health Protection Research Unit in Emerging Infections, University of Liverpool, said:

“The WHO’s decision not to declare the novel coronavirus outbreak in China a Public Health Emergency of International Concern (PHEIC) will surprise many.  The number of reported cases and deaths is doubling every couple of days, and patients have now been reported from many Asian countries, as well as the Middle East and United States.

“A PHEIC is declared when there is an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease. Such a declaration raises levels of international support, enhances diplomatic efforts and security, and releases more financial resource to support the response teams in the region. The downside of an unwarranted declaration is that it can impact on trade and tourism unnecessarily, and imply that a country has not been able to control the disease on its own. However, given the Chinese response of quarantining 18 million people in three major cities, this hardly seems like a consideration here.

“To date there have been five such public health emergencies declared by WHO: the 2009 H1N1 influenza pandemic (also known as swine flu), a 2014 declaration following the resurgence of wild poliovirus, the 2014 West African Ebola epidemic, the Zika emergency of 2015-16, and after much deliberation, the 2018-19 outbreak of Ebola in Kivu.

“The WHO feels that even without the declaration of a PHEIC there is already a co-ordinated international health response to the current coronavirus outbreak. And although the novel coronavirus is clearly spreading rapidly across China, the further spread to other countries is, so far, less dramatic. How infectious the virus is, i.e. how many new cases can be caused by one person is not yet clear. The case fatality rate, currently around 3-4%, is less than that of SARS (nearly 10 percent) or Ebola (around 50%). The WHO will want to monitor these developments further before deciding to declare a public health emergency.

“The Chinese authorities latest move to quarantine nearly 20 million people in three major cities underscores their determination to do everything they can to control the spread. Though whether it is really possible to isolate so many people, and whether at this stage it will really help control the epidemic is uncertain. In the UK, and other countries, passengers on flights coming directly from Wuhan are undergoing health screening and being given information about what to do if they feel unwell.“

Prof Martin Hibberd, Professor of Emerging Infectious Disease, London School of Hygiene and Tropical Medicine, said:

“This announcement is not surprising as more evidence may be needed to make the case of announcing a PHEIC. WHO were criticised after announcing the pandemic strain of novel H1N1_2009, when the virus was eventually realised to have similar characteristics to seasonal influenza and is perhaps trying to avoid making the same mistake here with this novel coronavirus. To estimate the true severity of this new disease requires identifying mild or asymptomatic cases, if there are any, while determining the human to human transmission rate might require more evidence. However, all this new evidence needs to be rapidly obtained over the next few days if the world is to be as prepared as possible, so WHO should issue a different type of alert to mobilise a full investigation.”

Dr Adam Kamradt-Scott, Associate Professor in the Centre for International Security Studies, University of Sydney, said:

“Based on the information we have to date, the WHO Director-General’s decision to not declare a public health emergency of international concern is not especially surprising. While we have seen international spread of the virus, which is one of the criteria for declaring a PHEIC, the cases in those countries do not appear to have seeded further local outbreaks. If that was to start to occur, it would constitute a greater concern but at the moment the outbreak is largely contained within China.

“Obviously the WHO will continue to closely monitor the situation, and this may be short-lived if local community transmission is detected outside of China. But for the moment, the fact the international community is already on high alert and many countries have put in place surveillance measures may help slow international spread.”

 Dr Jeremy Farrar, Director, Wellcome: 

“We respect the advice of the World Health Organization’s Emergency Committee to not declare a Public Health Emergency of International Concern (PHEIC) today, but this must be kept under constant review. Countries should act now on the recommendations made by the committee on how best to prepare and respond to this epidemic. There is no need to wait.

“The decision does not change the fact that the urgent focus must remain on identifying the gaps in understanding of this virus, and on a continued robust, coordinated global public health response. 

“This outbreak and the speed with which this new virus has spread in China and travelled across borders, is a reminder of how vulnerable we are globally to outbreaks of infectious diseases known and unknown. Travel restrictions may be important in buying time, to signal the seriousness of the situation and may help reduce the impact, but are unlikely stop this epidemic.

“Accelerating research as well as the public health response is key to bringing this under control. We still don’t fully understand how this virus is passing person to person, how and when people are infectious, the full range of clinical symptoms, or know the animal source. We don’t have proven treatments or vaccines.

“This virus has crossed from animals into people. That does not happen often, and it is without doubt, very serious. People are scarred by the memory of SARS, and a global outbreak of a novel respiratory virus like this, is something experts have warned about for many years.

“But we have also made important progress on epidemic preparedness. In the wake of the West African Ebola crisis, CEPI (the Coalition for Epidemic Preparedness Innovations) was founded. Today CEPI launched three programmes to speed vaccine research for this new coronavirus, and in China treatments are being tried and the information shared.

“While much uncertainty remains, it is vital to maintain focus on answering the critical unanswered questions and use the best available evidence to implement the most impactful public health response. This has to have the full support of the international community, be led by China, and co-ordinated by the WHO.  This is not just China’s problem, this is for all of us.”

Peter Piot, Professor of Global Health and Director, London School of Hygiene & Tropical Medicine, said:

“We are at a critical phase in this outbreak. Regardless of the decision not to declare this a Public Health Emergency of International Concern, intensified international collaboration and more resources will be crucial to stopping this outbreak in its tracks.  National authorities and the World Health Organization will need to continue to monitor developments very closely.

“There are still many missing pieces in the jigsaw puzzle to fully understanding this new virus which is spreading rapidly across China, and most probably around the world. Over the coming days and weeks we will know much more, but there cannot be any complacency as to the need for global action.

“The good news is that the data to date suggest that this virus may have a lower mortality than SARS, we have a diagnostic test and there is greater transparency than decades gone by. And that is essential because you cannot deal with a potential pandemic in one country alone.”

All our previous output on this subject can be seen at this weblink: https://www.sciencemediacentre.org/expert-reaction-to-wuhan-coronavirus-outbreak/

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