A Public Health Emergency of International Concern (PHEIC) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response", formulated when a situation arises that is "serious, sudden, unusual or unexpected", which "carries implications for public health beyond the affected state's national border" and "may require immediate international action".[1] Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to a PHEIC.[2][3] The declaration is publicized by an IHR Emergency Committee (EC) of international experts,[4] which was developed following the SARS outbreak in 2002–03.[5]
Since 2009, there have been six PHEIC declarations:[6][7] the 2009 H1N1 (or swine flu) pandemic, the 2014 polio declaration, the 2014 outbreak of Ebola in Western Africa, the 2015–16 Zika virus epidemic,[8] the 2018–20 Kivu Ebola epidemic,[9] and the ongoing COVID-19 pandemic.[10] The recommendations are temporary and require reviews every three months.[1]
SARS, smallpox, wild type poliomyelitis, and any new subtype of human influenza are automatically PHEICs and thus do not require an IHR decision to declare them as such.[11] A PHEIC is not confined to infectious diseases, and may cover an emergency caused by exposure to a chemical agent or radioactive material.[12] In any case within its ambit, it is a "call to action" and "last resort" measure.[13]
Contents
- 1 Background
- 2 Definition
- 3 Reporting a potential concern
- 4 Emergency Committee
- 5 Declarations
- 5.1 2009 swine flu declaration
- 5.2 2014 polio declaration
- 5.3 2014 Ebola declaration
- 5.4 2016 Zika virus declaration
- 5.5 2018–20 Kivu Ebola dec
A Public Health Emergency of International Concern (PHEIC) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response", formulated when a situation arises that is "serious, sudden, unusual or unexpected", which "carries implications for public health beyond the affected state's national border" and "may require immediate international action".[1] Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to a PHEIC.[2][3] The declaration is publicized by an IHR Emergency Committee (EC) of international experts,[4] which was developed following the SARS outbreak in 2002–03.[5]
Since 2009, there have been six PHEIC declarations:[6][7] the 2009 H1N1 (or swine flu) pandemic, the 2014 polio declaration, the 2014 outbreak of Ebola in Western Africa, the 2015–16 Zika virus epidemic,[6][7] the 2009 H1N1 (or swine flu) pandemic, the 2014 polio declaration, the 2014 outbreak of Ebola in Western Africa, the 2015–16 Zika virus epidemic,[8] the 2018–20 Kivu Ebola epidemic,[9] and the ongoing COVID-19 pandemic.[10] The recommendations are temporary and require reviews every three months.[1]
SARS, smallpox, wild type poliomyelitis, and any new subtype of human influenza are automatically PHEICs and thus do not require an IHR decision to declare them as such.[11] A PHEIC is not confined to infectious diseases, and may cover an emergency caused by exposure to a chemical agent or radioactive material.[12] In any case within its ambit, it is a "call to action" and "last resort" measure.[13]
Multiple surveillance and response systems exist worldwide for the early detection and effective response to contain the spread of disease. Time delays still occur for two main reasons, however. The first is the delay between the first case and the confirmation of the outbreak by the healthcare system, allayed by good surveillance via data collection, evaluation, and organisation. The second is when there is a delay between the detection of the outbreak and widespread recognition and declaration of it as an international concern.[5] The declaration is promulgated by an Emergency Committee (EC) made up of international experts operating under the IHR (2005),[4] which was developed following the SARS outbreak of 2002/2003.[5] Between 2009 and 2016, there were four PHEIC declarations.[7] The fifth was the 2018–20 Kivu Ebola epidemic which was announced on 17 July 2019.[9] The sixth is the 2019–20 novel coronavirus pandemic.[10] Under the 2005 International Health Regulations (IHR), States have a legal duty to respond promptly to a PHEIC.[2]
Definition
PHEIC is defined as;
an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.[14]
This definition designates a public health crisis of potentially global reach and implies a situation that is "serious, sudden, unusual or unexpected", which may necessitate immediate international action.[14][15]
It is a "call to action" and "last resort" measure.[13]
Reporting a potential concern
WHO Member States have 24 hours within which to report potential PHEIC events to the WHO.[11] It does not have to be a member State that reports a potential outbreak, hence reports to the WHO can also be received informally.[16] Under the IHR (2005), ways to detect, evaluate, notify and report events were ascertained by all countries in order to avoid PHEICs. The response to public health risks was also decided.[13]
The IHR decision algorithm assists WHO Member States in deciding whether a potential PHEIC exists and the WHO should be notified. The WHO should be notified if any two of the four following questions are affirmed:[11]
- Is the public health impact of the event serious?
- Is the event unusual or unexpected?
- Is there a significant risk for international spread?
- Is there a significant risk for international travel or trade restrictions?
The PHEIC criteria include a list of diseases that are always notifiable.[16] SARS, smallpox, wild type poliomyelitis and any new subtype of human influenza are always a
PHEIC is defined as;
an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.[14]
Th
an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.[14]
This definition designates a public health crisis of potentially global reach and implies a situation that is "serious, sudden, unusual or unexpected", which may necessitate immediate international action.[14][15]It is a "ca
It is a "call to action" and "last resort" measure.[13]
WHO Member States have 24 hours within which to report potential PHEIC events to the WHO.[11] It does not have to be a member State that reports a potential outbreak, hence reports to the WHO can also be received informally.[16] Under the IHR (2005), ways to detect, evaluate, notify and report events were ascertained by all countries in order to avoid PHEICs. The response to public health risks was also decided.[13]
The IHR decision algorithm assists WHO Member States in deciding whether a potential PHEIC exists and the WHO should be notified. The WHO should be notified if any two of the four following questions are affirmed:[11]
- Is the public health impact of the event serious?
- Is the
The IHR decision algorithm assists WHO Member States in deciding whether a potential PHEIC exists and the WHO should be notified. The WHO should be notified if any two of the four following questions are affirmed:[11]
The PHEIC criteria include a list of diseases that are always notifiable.[16] SARS, smallpox, wild type poliomyelitis and any new subtype of human influenza are always a PHEIC and do not require an IHR decision to declare them as such.[14]
Large scale health emergencies which attract public attention do not necessarily fulfill the criteria to be a PHEIC.[13] EC's were not convened for the Large scale health emergencies which attract public attention do not necessarily fulfill the criteria to be a PHEIC.[13] EC's were not convened for the cholera outbreak in Haiti, chemical weapons use in Syria or the Fukushima nuclear disaster in Japan, for example.[12][17]
Further assessment is required for diseases which are prone to pandemics, including but not limited to cholera, pneumonic plague, yellow fever, and viral hemorrhagic fevers.[17]
A declaration of a PHEIC may appear as an economic burden to the state facing the epidemic. Incentives to declare an epidemic are lacking and the PHEIC can be seen as placing limitations on trade in countries that are already struggling.[13]
In order to declare a PHEIC, the WHO Director-General is required to take into account factors which include the risk to human health and international spread as well as advice from an internationally made up committee of experts, the IHR Emergency Committee (EC), one of which should be an expert nominated by the State within whose region the event arises.[1] Rather than being a standing committee, the EC is created ad hoc.[18]
Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms now they are. These members are selected according to the disease in question and the nature of the event. Names are taken from the IHR Experts Roster. The Director-General takes the EC's advice following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration, the EC then makes recommendations on what actions the Director-General and Member S
Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms now they are. These members are selected according to the disease in question and the nature of the event. Names are taken from the IHR Experts Roster. The Director-General takes the EC's advice following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration, the EC then makes recommendations on what actions the Director-General and Member States should take to address the crisis.[18] The recommendations are temporary and require three-monthly reviews.[1]
In the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in Mexico, North America and spread quickly across the US and the world.[19] On 26 April 2009,[20] more than one month after its first emergence,[5] the first PHEIC was declared when the H1N1 (or swine flu) pandemic was still in Phase Three.[2][21][22] On the same day, within three hours the WHO web site received almost two million visits, necessitating the pandemic's own dedicated pandemic influenza web site.[20] At the time H1N1 had been declared a PHEIC, it had so far occurred in only three countries.[5] Declaring H1N1 a PHEIC has therefore been argued as fueling public fear.[17] However, a 2013 study sponsored by the WHO estimated that although the H1N1 pandemic was similar in magnitude to seasonal influenza, it resulted in the loss of more life-years due to a shift toward mortality among persons less than 65 years of age.[23]
2014 polio declaration
The second PHEIC was the 2014 polio declaration, issued in May 2014 with the resurgence of wild polio after its near-eradication, deemed "an extraordinary event".[24][25]
Global eradication was deemed to be at risk with small numbers of cases in Afghanistan, Pakistan, and Nigeria.[17]
In October 2019, continuing cases of wild polio in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia, was reviewed and remains a PHEIC.2014 polio declaration, issued in May 2014 with the resurgence of wild polio after its near-eradication, deemed "an extraordinary event".[24][25]
Global eradication was deemed to be at risk with small numbers of cases in Afghanistan, Pakistan, and Nigeria.[17]
In October 2019, continuing cases of wild polio in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia, was reviewed
Global eradication was deemed to be at risk with small numbers of cases in Afghanistan, Pakistan, and Nigeria.[17]
In October 2019, continuing cases of wild polio in Pakistan and Afghanistan, in addition to new vaccine-derived cases in Africa and Asia, was reviewed and remains a PHEIC.[26] It was extended on 11 December 2019.[27]
Confirmed cases of Ebola were being reported in Guinea and Liberia in March 2014 and Sierra Leone by May 2014. On Friday, 8 August 2014, following the occurrence of Ebola in the United States and Europe and with the already intense transmission ongoing in three other countries for months,[13] the WHO declared its third PHEIC in response to the outbreak of Ebola in Western Africa.[28] Later, one review showed that a direct impact of this epidemic on America escalated a PHEIC declaration.[5] It was the first PHEIC in a resource-poor setting.[13]
2016 Zika virus declaration
In 2018, an examination of the first four declarations (2009–2016) showed that the WHO was noted to be more effective in responding to international health emergencies, and that the international system in dealing with these emergencies was "robust".[8]
Another review of the first four declarations, with the exception of wild polio, demonstrated that responses were varied. Severe outbreaks, or those that threatened larger numbers of people, did not receive a swift PHEIC declaration, and the study hypothesized that responses were quicker when American citizens were infected and when the emergencies did not coincide with holidays.[5]
Non-declarations
2013 MERS
[8]Another review of the first four declarations, with the exception of wild polio, demonstrated that responses were varied. Severe outbreaks, or those that threatened larger numbers of people, did not receive a swift PHEIC declaration, and the study hypothesized that responses were quicker when American citizens were infected and when th
Another review of the first four declarations, with the exception of wild polio, demonstrated that responses were varied. Severe outbreaks, or those that threatened larger numbers of people, did not receive a swift PHEIC declaration, and the study hypothesized that responses were quicker when American citizens were infected and when the emergencies did not coincide with holidays.[5]
PHEIC was not invoked with the Middle Eastern Respiratory Syndrome (MERS) outbreak in 2013.[62][63] Originating in Saudi Arabia, MERS reached more than 24 countries and resulted in more than 580 deaths by 2015, although most cases were in hospital settings rather than sustained community spread. What constitutes a PHEIC has, as a result, been unclear.[12][6] As of May 2020, there has been 876 deaths.[6][64]
Non-infectious events
PHEIC are not confined to only infectious diseases. It may cover events caused by chemical agents or radioactive materials.[12]
The emergence and spread of antimicrobial resistance may debatably constitute a PHEIC.[65][66][67]
See also
References
[12]The emergence and spread of antimicrobial resistance may debatably constitute a PHEIC.[65][66]The emergence and spread of antimicrobial resistance may debatably constitute a PHEIC.[65][66][67]
