IJID: Making The Case For Designating Measles Resurgence A PHEIC

#14,098

Three weeks ago, in WHO Update & Risk Assessment: Measles In Europe, the World Health Organization reported a major increase in measles during the first quarter of 2019. Last February, in Philippines DOH Declares & Then Expands Measles Outbreak Declaration, after an almost 10-fold increase in cases during the first 19 days of 2019 over the previous year.

Ten days ago, the CDC held a COCA Call: Most Measles Cases In 25 Years, which asked the question `Is This the End of Measles Elimination in the United States?'

According to the WHO, `Even though a safe and cost-effective vaccine is available, in 2017, there were 110 000 measles deaths globally, mostly among children under the age of five.'

A number which seems destined to rise significantly in 2019.

The June edition of the International Journal of Infectious Diseases contains an editorial assessment (see below) making the case for declaring this global resurgence a `PHEIC', a Public Health Emergency of International Concern. 

This is a relatively lengthy and detailed report, and so I've only posted the opening salvos of their argument and their conclusions. Follow the link to read the open-access article in its entirety.

I'll have a postscript when you return.

Is the global measles resurgence a “public health emergency of international concern”?

David N. Durrheim, Natasha S. Crowcroftb, Lucille H. Blumbergc

Corresponding Editor: Eskild Petersen, Aarhus, Denmark

DOI: https://doi.org/10.1016/j.ijid.2019.04.016

Highlights

• Public Health Emergencies of International Concern require coordinated international responses.
• There has been a recent alarming global increase in measles deaths and unprecedented rapid international spread.
• Measles is re-established in the Americas, and in certain Western Pacific and European countries.
• Mobilisation of extraordinary resources by the international community is urgently required.

The 2005 revision of the International Health Regulations (IHR) came into force on 15 June 2007 and is legally binding on 196 countries, including all the Member States of World Health Organization (WHO). In the IHR, a public health emergency of international concern (PHEIC) is defined as: “an extraordinary event that may constitute a public health risk to other countries through international spread of disease and may require an international coordinated response.” (World Health Organization, 2005). The IHR requires that countries notify the WHO of any public health event that meets any two of the following four criteria: Is the public health impact of this event potentially serious?; Is this event unusual or unexpected?; Is there the potential for international spread?; or Is there the potential for travel and trade restrictions?

The purpose of declaring a PHEIC is to focus attention on those acute public health risks that have the potential to cross borders and threaten people worldwide, and “require coordinated mobilisation of extraordinary resources by the international community” for prevention and response. The decision to declare a PHEIC rests with the WHO Director-General.

To date four PHEICs have been declared; the: 2009 H1N1 influenza pandemic declaration; 2014 polio declaration; 2014 Ebola declaration with the outbreak in West Africa; and 2016 Zika virus declaration. The polio PHEIC declaration stands apart as poliovirus is certainly not a novel or emerging pathogen, but it sets an interesting and laudable precedent. The PHEIC issued on 5 May 2014 references the resurgence of polio after its near-eradication, deeming this an “extraordinary event and a public health risk to other States for which a coordinated international response is essential” (World Health Organization, 2014). This is the only PHEIC that remains in effect, five years after it was first declared.

        (BIG SNIP)

Should “extraordinary resources” be mobilised by the international community to respond to this public health risk that has the potential to cross borders and threaten people worldwide? If we follow the advice that Plato put in the mouth of Socrates, “we must go wherever the wind of the argument carries us.” (Plato, 1974) Thus the answer must be “yes” – measles is a de facto PHEIC – it should be declared!.

        (Continue . . . )


The bar for declaring a PHEIC is purposefully set pretty high, which was illustrated last October when the WHO IHR Committee Determined The DRC Ebola Outbreak Was Not A PHEIC. 

Despite offering some compelling arguments, I suspect selling the idea of designating Measles as a PHEIC to the IHR committee is likely to prove difficult, considering that the IHR committee reiterated their decision not to do so for the rapidly growing Ebola outbreak in the DRC last April.

Whether they would find it worthy or not, convening a meeting of the IHR Committee to discuss the situation would bring a lot of international attention to the severity of the global measles problem, and perhaps spur more action.

And that would be a small step in the right direction.