In 2005, the 194 member states of the World Health Organization (WHO) - following the reporting debacle surrounding SARS in 2002-2003 (see SARS and Remembrance) - approved the biggest change to the IHR (International Health Regulations) since 1969.
IHR 2005 required that all member nations develop mandated surveillance and testing systems and to report certain disease outbreaks and public health events to WHO in a timely manner (usually within 48 hours).
While this has generally led to better disease surveillance and reporting, the reality is that nearly 2 decades on, many countries still lack the ability to conduct surveillance and testing (see Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries), while some other countries - presumably capable of reporting outbreaks - only do so when it suits them.
We often only hear about human avian flu infections from China months after the fact and their reporting on SARS-CoV-2 has been anything but open. We've seen prolonged shutdowns in reporting on MERS from Saudi Arabia, and other Middle Eastern countries, lasting many months.
There are plenty of examples, from other countries, not eager to divulge what they consider `negative' information.
The WHO diplomatically `reminds' member nations at every opportunity of their obligation (under IHR 2005) to promptly report outbreaks, or novel diseases, but only rarely have we seen the WHO `call out' a nation for their lack of cooperation (see here, and here).
Over the past 18 months, in an attempt to move past the SARS-CoV-2 pandemic, many countries have simply stopped reporting - internally, or to the WHO - on COVID cases, hospitalizations, or deaths (see WHO: Countries Reporting COVID Data Continues To Decline).
In their most recent Weekly Epidemiological Report On COVID, the WHO reports:
- Only 13% of nations reported hospitalization data in the past 28 days.
- Only 11% reported on ICU admissions over the past four weeks.
- The African Region and the Eastern Mediterranean Region did not report ICU admissions during the 28-day period
And that is an assumption that could easily come back and bite us when we aren't looking.
Today, the World Health Organization has released a 5-page document outlining the D-G's `recommendations' for continuing to monitor - and mitigate - COVID under the IHR 2005 agreement.
Due to its length I've only posted the opening summary, and the headings for each of the 7 diplomatically worded recommendations. Follow the link to read the full document:
These standing recommendations are issued by the Director-General of the World Health Organization (WHO) in accordance with provisions of Articles 16 to 18, and 50 to 53 of the International Health Regulations (2005) (IHR or Regulations).These standing recommendations are in effect for all States Parties from 9 August 2023 until 30 April 2025.These standing recommendations may be modified or terminated prior to that time, in accordance with Article 53 of the Regulations. Furthermore, they will be submitted to the Seventy-Seventh World Health Assembly for its consideration, pursuant to Article 53 (g) of the IHR.In accordance with the advice provided to the Director-General of WHO by both the IHR Emergency Committee regarding the COVID-19 pandemic and the IHR Review Committee regarding standing recommendation for COVID-19 , these standing recommendations, based on scientific principles and evidence, are necessary and appropriate to support States Parties in addressing the risk posed by COVID19 during the transition from the response to a public health emergency of international concern to its management within broader disease prevention and control programmes4.Both the Review Committee regarding standing recommendations for COVID-19 and the Director-General underscore that the standing recommendations have been formulated and issued in strict compliance with relevant provisions of the IHR. Accordingly, these standing recommendations should be understood as respecting the ongoing work by Member States in the framework of the Intergovernmental Negotiating Body (INB) and the Working Group on Amendments to the International Health Regulations (2005) (WGIHR), and are not intended to interfere with or unduly influence that work
(Recommendations)
A. States Parties are recommended to revise and implement, as appropriate, national COVID19 plans and policies that take into account the WHO COVID-19 Strategic Preparedness and Response Plan April 2023- April 2025. This document outlines critical actions that support States Parties in transitioning from emergency response to COVID-19 into strengthened and integrated infectious disease prevention and control programmes with the goal of reducing disease burden from COVID-19 and preparing for a possible worsening situation caused by new variants of the virus
B. States Parties are recommended to sustain collaborative surveillance for COVID-19, in order to provide a basis for situational awareness and risk assessment and the detection of significant changes in virus characteristics, virus spread, disease severity and population immunity.
C. States Parties are recommended to continue reporting COVID-19 data, particularly mortality data, morbidity data, SARS-CoV-2 genetic sequences with meta-data, and vaccine effectiveness data to WHO or in open sources so that WHO can understand and describe the epidemiological situation and variant landscape, perform global risk assessments and work with expert networks and relevant WHO Advisory Groups
D. States Parties are recommended to continue to offer COVID-19 vaccination based on both, the recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and on national prioritization informed by cost benefit reviews. Vaccine delivery should be appropriately integrated into health services.
E. States Parties are recommended to continue to initiate, support, and collaborate on research to generate evidence for COVID-19 prevention and control, with a view to reduce the disease burden of COVID-19.
F. States Parties are encouraged to continue deliver optimal clinical care for COVID-19, appropriately integrated into all levels of health services, including access to proven treatments and measures to protect health workers and caregivers as appropriate
G. States Parties are encouraged to continue to work towards ensuring equitable access to safe, effective and quality-assured medical countermeasures for COVID-19.
While I doubt that many governments that are already disinclined to report cases, and have `moved on', will be suddenly swayed by this document, this should be a reminder to the rest of us that COVID isn't necessarily over.
Unfortunately, we're seeing a number of countries decide - for economic, political, or societal reasons - that official silence on outbreaks, or `slow-walking' information, can be a useful strategy (see Flying Blind In The Viral Storm).But even if it is, there are other emerging threats out there.
