Statement on the tenth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic

The tenth meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19) pandemic took place on Thursday 13 January 2022 from 12:00 to 17:00 Geneva time (CEST).

Proceedings of the meeting

Members and Advisors of the Emergency Committee were convened by videoconference.

The Director-General welcomed the Committee members and advisers. He highlighted the challenges posed by the high transmission levels of the SARS CoV-2 Omicron variant of concern (VOC) and the corresponding burden on public health systems and health service delivery. The Director-General emphasized the importance of vulnerable populations in all countries getting timely and equitable access to COVID-19 vaccination. The Director-General encourages all efforts to expand access to and uptake of vaccination, with the expectation that those who have access to vaccines get vaccinated and continued adherence to PHSM. The DG expressed hope that, by working together, the world can bring an end to the acute phase of the COVID-19 pandemic.

Representatives of the Office of Legal Counsel (LEG) and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities. The Ethics Officer from CRE provided the members and advisers with an overview of the WHO Declaration of Interests process. The members and advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each member who was present was surveyed. No conflicts of interest were identified. 

The Secretariat turned the meeting over to the Chair, Professor Didier Houssin. Professor Houssin noted the continuing challenges caused by SARS-CoV-2 nearly two years after the first meeting of this Committee. He reviewed the objectives and agenda of the meeting. 

The Secretariat presented on the current status of the COVID-19 pandemic and a vision for how to optimize the 2022 response to the COVID-19 pandemic. The presentation focused on:

• the global epidemiological context including an overview of the Omicron VOC;
• factors that continue to drive transmission, potential future scenarios which may involve variants that are more or less severe, and challenges posed by the continued evolution of SARS-CoV-2 in animal and human reservoirs;
• the status of COVID-19 vaccines and vaccination targets for 2022; and
• updates on international traffic and progress on the Temporary Recommendations issued following the 9^th meeting of the Emergency Committee.   

The Committee discussed key issues including:

• challenges and opportunities to harmonize national and global response efforts within the context of the synchronous outbreaks of Omicron VOC, including in relation to international travel;
• drivers for emergence of new VOCs as well as differences in the characteristics of Delta and Omicron VOCs and their respective lineages;
• the evolution of SARS-CoV-2 testing strategies as well as accessibility and affordability of medical countermeasures;
• vaccination strategies and the use of heterologous vaccine combinations;
• the challenges to maintain continued community buy-in for public health and social measures after two years of the pandemic and the risk of overly optimistic statements regarding the state of the pandemic;
• the increasing levels of threat and concerns about personal safety faced by frontline responders, advisors and leaders of the pandemic response;
• the focus of response efforts on a combination of suppression of transmission and mitigation of severe outcomes; and
• the need for an on-going integrated One Health approach to SARS-CoV-2 surveillance, research, and response efforts. 

The Committee praised South Africa for their rapid identification, and transparent and rapid sharing of information on the Omicron VOC. The Committee was concerned about the reaction of States Parties in implementing blanket travel bans, which are not effective in suppressing international spread (as clearly demonstrated by the Omicron experience), and may discourage transparent and rapid reporting of emerging VOC. 

The Committee noted with concern reports of violence against health workers, public health officials, and expert advisors engaged in the COVID-19 response. The Committee condemns these acts that undermine national and global response efforts. 

The Committee expressed deep concern that countries not eligible for the COVAX Facility Advance Market Commitment (AMC) are experiencing challenges affording COVID-19 vaccines. In addition, they noted challenges posed by the high prices of certain therapeutics, the lack of equity in access, and limited data availability on cost-effectiveness of these treatments. The Committee urged WHO to continue its work with the pharmaceutical sector to address barriers to access and affordability, by expanding tiered pricing, voluntary license agreements and other approaches to increase access to vaccines, therapeutics, and diagnostic tests for all countries, possibly looking at the Pandemic Influenza Preparedness Framework for guidance. 

While current vaccines continue to be effective in reducing risk of severe disease and death due to COVID-19, they do not completely eliminate the risk of transmission of SARS-CoV-2 (all variants). A coordinated global strategy is critical for assuring protection of high-risk populations everywhere, with particular focus in countries that have low vaccination rates, especially those with a rate below 10%. To derive the optimal vaccination strategy for reducing infection, morbidity and mortality, the Committee stressed the importance of coordinating research on heterologous vaccine combinations, considering also the natural immunity following infection, and the need for manufacturers to produce and share the relevant data. In addition, the Committee noted the importance of expediting research and development on novel vaccine technologies. The current vaccination technology is dependent on syringes which are in limited supply, presenting a significant logistical and programmatic burden. Rapid development of alternative vaccine formulations, such as intranasal vaccines, could increase the ease of delivery in low resource and/or hard to reach areas. Also, there is a clear need for continued work on vaccines that confer broader immunity across variants.  The Committee acknowledged the work of other WHO technical advisory groups such as the Scientific and Technical Advisory Group on Infectious Hazards (STAG-IH), the Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC), the Strategic Advisory Group of Experts on Immunization (SAGE), the Research and Development Blueprint for Epidemics working groups and the Technical Advisory Group on SARS-CoV-2 Virus Evolution (TAG-VE) that are having on-going in-depth discussions on the key elements of vaccine composition, strategy development, and virus evolution, and are regularly reporting on their findings.

The Committee recognized the challenges in sensitivity and quality posed by the multitude of existing SARS-CoV-2 diagnostic tests in light of the evolving virus, and the lack of appropriate approval for some of their uses, for example testing for access to facilities. This highlighted the need for coherent testing strategies, with clear articulation of what type of tests are to be used for what purposes.  The Committee noted the need for regulatory authorities to ensure diagnostic tests meet the WHO standards on specificity and sensitivity for the different applications, including use of assays for testing for access. Continued coordination amongst States Parties is needed to ensure availability and use of high-quality rapid antigen tests in all countries for an effective global response to the pandemic. 

The Committee recognized the challenges to maintain continued community buy in for public health and social measures (PHSM) after nearly two years of the COVID-19 pandemic and the risk of overly optimistic statements regarding the state of the pandemic. The Committee further emphasized the need to uphold the ethical and human rights considerations in the application of individualized PHSM, as per WHO guidance. 

The Committee unanimously agreed that the COVID-19 pandemic still constitutes an extraordinary event that continues to adversely affect the health of populations around the world, poses a risk of international spread and interference with international traffic, and requires a coordinated international response. As such, the Committee concurred that the COVID-19 pandemic remains a PHEIC and offered its advice to the Director-General. 

The Director-General determined that the COVID-19 pandemic continues to constitute a PHEIC. He accepted the advice of the Committee and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR 

The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General. The Director-General thanked the Committee for its work.

 

Temporary Recommendations to States Parties

The Committee identified the following actions as critical for all countries:

1. MODIFIED: Continue to use evidence-informed public health and social measures, therapeutics, diagnostics, and vaccines for COVID-19, and to share response experiences with WHO.  States Parties are advised to regularly adjust their response strategies by monitoring their epidemiological situation, assessing their vulnerabilities including their health system capacity, as well as considering the adherence to and attributable impact of individual and combined PHSM. Where isolation and quarantine of large numbers of cases and contacts is potentially disrupting critical infrastructure (including heath care services), States Parties may need to modify isolation and quarantine periods, with the introduction of testing, to balance the risks with the continuation of key functions, using a risk-based approach. Technical Brief on enhancing Readiness for Omicron and Considerations for implementing and adjusting public health and social measures in the context of COVID-19.
2. MODIFIED: Take a risk-based approach to mass gathering events by evaluating, mitigating, and communicating risks. Recognizing that there are different drivers and risk tolerance for mass gatherings and mass migrations, and the particular challenges for fragile and vulnerable States Parties, it is critical to consider the epidemiological context (including the prevalence of variants of concern and the intensity of transmission), surveillance, contact tracing and testing capacity, as well as adherence to PHSM when conducting this risk assessment in line with WHO guidance. Key planning recommendations for mass gatherings in the context of COVID-19.
3. MODIFIED: Achieve the WHO call to action to have at least 70% of all countries’ populations vaccinated by the start of July 2022 and integrate COVID-19 vaccination into routine health services. In accordance with advice from SAGE and WHO interim statements, States Parties are requested to share vaccine doses to increase global equity and to use a stepwise approach to vaccination, prioritizing those at highest risk from COVID-19, considering an evidence-informed use of booster vaccination, and taking into account evolving data on population level immunity. To enhance vaccine uptake, States Parties are encouraged to assess enablers and barriers to vaccination. Vaccination programmes should continue to prioritize vulnerable populations, including health workers, older people, people with underlying conditions, immunocompromised individuals with insufficient access to treatment, migrants, refugees, people living in fragile settings, sea farers, and air crews. Interim Statement on COVID-19 vaccines in the context of the circulation of the Omicron SARS-CoV-2 Variant from the WHO Technical Advisory Group on COVID-19 Vaccine Composition (TAG-CO-VAC); Link to WHO SAGE Prioritization Roadmap

4. MODIFIED: Enhance surveillance of SARS-CoV-2 and continue to report to WHO to enable rapid identification, tracking, and evaluation of variants and continued monitoring of the pandemic’s evolution and its control. States Parties should strengthen systems to collect and publicly share indicators to monitor the burden of COVID-19, such as hospitalization rates, severe disease, and excess mortality. States Parties are particularly encouraged to increase efforts to increase detection of infections in individuals where variants of interest and variants of concern may emerge. States Parties should strengthen mechanisms to link individual-level clinical, vaccination and genomic data to facilitate assessment of the impact of and vaccine effectiveness against VOC. States Parties should leverage and enhance existing systems such as the Global Influenza Surveillance and Response System (GISRS), as well as other national, regional, and global networks to integrate respiratory disease surveillance and prioritize monitoring circulation of SARS-CoV-2, relative proportions of SARS-CoV-2 variants, and circulation of other co-circulating respiratory viruses, including influenza. Guidance for surveillance of SARS-CoV-2 variants; SARS-CoV-2 genomic sequencing for public health goals
5. MODIFIED: States Parties should ensure that there is sufficient surge capacity for critical SARS-CoV-2 clinical care and post COVID-19 condition, and for the maintenance of essential health services, and should plan for the restoration of health services at all levels with sufficient funding, supplies, and human resources. Specific to the risk of evolving new lineages, special attention may be needed for ensuring access to treatment for treatable immunosuppressive disease. States Parties should enhance access to health for all by strengthening health and social systems to cope with the impacts of the pandemic, especially on children. Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: WHO position paper
6. MODIFIED: Lift or ease international traffic bans as they do not provide added value and continue to contribute to the economic and social stress experienced by States Parties. The failure of travel restrictions introduced after the detection and reporting of Omicron variant to limit international spread of Omicron demonstrates the ineffectiveness of such measures over time. Travel measures (e.g. masking, testing, isolation/quarantine, and vaccination) should be based on risk assessments and avoid placing the financial burden on international travellers in accordance with Article 40 of the IHR.  WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant 
7. EXTENDED: Do NOT require proof of vaccination against COVID-19 for international travel as the only pathway or condition permitting international travel given limited global access and inequitable distribution of COVID-19 vaccines. State Parties should consider a risk-based approach to the facilitation of international travel by lifting or modifying measures, such as testing and/or quarantine requirements, when appropriate, in accordance with the WHO guidance.  Interim position paper: considerations regarding proof of COVID-19 vaccination for international travellers; Policy considerations for implementing a risk-based approach to international travel in the context of COVID-19 
   
   
8. MODIFIED: Recognize all vaccines that have received WHO Emergency Use Listing and all heterologous vaccine combinations as per SAGE recommendations, including in the context of international travel. States Parties are also requested to support research to derive the optimal vaccination strategy for reducing infection, morbidity and mortality. Interim Recommendations for heterologous COVID-19  Vaccine Schedules ; WHO Emergency Use Listing 
9. MODIFIED: Address community engagement and communications gaps and challenges posed by infodemics at national and local levels to reduce COVID-19 transmission, counter misinformation and threats to frontline workers, and improve COVID-19 vaccine acceptance, where applicable. This will require reinforcing messages that a comprehensive public health response is needed, including the continued use of PHSM alongside increasing vaccination coverage. Given the rapidly evolving situation and to promote trust and adherence, States Parties should explain clearly and transparently the rationale for the changes of policies and PHSM, with a view to balance risks and benefits of such changes. These communications need to be tailored to different population groups, including those considered as most vulnerable. Link to WHO risk communications resources.
10. MODIFIED: Support timely uptake and monitoring of WHO recommended therapeutics by addressing challenges with accessibility and appropriate use. Local production and technology transfer can contribute to global equitable access to therapeutics. States Parties are advised to establish COVID-19 therapeutics resistance monitoring systems, using appropriate testing strategies and strengthening their surveillance system. In addition, States Parties are requested to support pharmacovigilance cohort studies and reporting systems to detect adverse events following administration of new therapeutics. Therapeutics and COVID-19: living guideline
11. NEW: Conduct epidemiological investigations of SARS-CoV-2 transmission at the human-animal interface and targeted surveillance on potential animal hosts and reservoirs. Real time monitoring and data sharing on SARS-Cov-2 infection, transmission and evolution in animals will assist global understanding of the virus epidemiology and ecology, the potential for evolution of new variants in animal populations, their timely identification, and assessment of their public health risks. Statement from the Advisory Group on SARS-CoV-2 Evolution in Animals