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expert reaction to WHO’s decision to declare the Wuhan coronavirus outbreak a PHEIC (Public Health Emergency of International Concern)

The WHO has declare the Wuhan coronavirus outbreak a Public Health Emergency of International Concern (PHEIC).

 

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“This was to be expected, especially given the ramping up of infections in China, increasing numbers of other countries reporting cases of coronavirus infection, and the real threat that this infection poses to global health, especially in places that lack adequate surveillance and infrastructure.“We need to gain a better understanding of how the virus is behaving if we have any chance of bringing this outbreak to a close and a concerted and increased international effort in  the best way to achieve this; I just hope that it is not too late.“

 

Dr Bharat Pankhania, Senior Clinical Lecturer, University of Exeter Medical School, said: 

“The WHO declaration of the PHEIC was an expected outcome. At the last meeting of the WHO experts committee, they were split 50:50.  A PHEIC is declared when there is an extraordinary event. It can be triggered by infectious agents or other incidents too. 

“Now that we have isolated  the virus in several distant countries, showing evidence of clear person-to-person transmission as well as 2ndand 3rd generation secondary cases (meaning a carrier can inject someone else who also goes on to infect others). In addition,  because of the increasing number of cases in the Wuhan and other Chinese provinces ,it became inevitable that this time the WHO would feel all their criteria for declaring a PHEIC had been met. 

“Furthermore, there has been growing international concern due to cases being diagnosed in distant parts of the world. All these issues made declaring a PHEIC inevitable.

“As a result of this formal declaration, member states are obliged to work together in managing the outbreak, release resources and share diagnostics as well as logistics expertise, thus it now formalises what would have been going on in the background amongst member states. Under the 2005 International Health Regulations (IHR), member states have a legal duty to respond promptly to a PHEIC.

“We have had several recent PHEIC declarations. For example, Swine Flu, SARS, Zikha virus, some infections such as Smallpox would result in an immediate declaration of PHEIC. The WHO declaration is not a cause for escalated worry, but we have to remain concerned and work with member states in gathering information, sharing logistics, and other abilities, such as testing clinical samples, vaccine manufacture.”

 

Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said: 

It is entirely appropriate and proportionate that the World Health Organization have declared that the novel coronavirus outbreak is a Public Health Emergency of International concern. It meets the criteria in that it is a completely new virus, it has spread internationally and it requires immediate international action. What has changed between the previous WHO meeting and now is that there has been person-to-person spread outside China. This indicates a significant risk of major outbreaks occurring in other countries.

“In some respects the PHEIC declaration changes little: the UK and many other countries have already started their preparations to introduce appropriate public measures should they have an epidemic. The PHEIC does, however, emphasize the need for all countries to do their best to contain the virus. The current definition of a suspected case includes links with Wuhan. If this definition has to be widened, to the whole of China, or to include other countries then the number of suspect cases would soon increase to unmanageable levels.

Countries with weaker health systems may require assistance to implement the WHO’s recommendations: to conduct effective surveillance, diagnosis, reporting, case management and wider protective measures. It is everyone’s interests that they are quickly given that assistance.”

 

Dr Nathalie MacDermott, NIHR Academic Clinical Lecturer, King’s College London, said:

“It is right that the World Health Organisation have declared the 2019-nCoV outbreak a Public Health Emergency of International Concern. The development over the last few days that there is now confirmed onward transmission of the virus in countries outside of China and involving individuals who had not travelled to China, has  meant that one of the fundamental criteria for the declaration of a PHEIC has been met. While the declaration of a PHEIC does not necessarily change anything directly, it heightens awareness of the situation throughout the world and opens up potential financial support through donor funds which are restricted only to emergencies.

“While developed nations have robust health infrastructures that should be able to contain the virus and limit its spread, this is not the case for low income nations. It is therefore important that support is provided to such nations to enable rapid testing and isolation of cases and should there be an escalating situation to promptly provide additional expertise and assistance through the emergency medical teams structure.”

 

Prof Trudie Lang, Director, The Global Health Network,Nuffield Department of Medicine, University of Oxford, said: 

“The WHO have reached this decision because the situation has changed from last week, when the committee was divergent in their views.  The criteria for reaching the rare event of designating a Public Health Emergency are the potential level of global impact, the need for a ‘call to action’ through global coordination, and that the situation is sudden and unexpected, as we saw with the Zika virus outbreak, for example. Since then there have been 98 cases outside of China, and the critical element is that a small proportion of these infections have occurred through person-to-person transmission.  Even though the relative number of cases outside of China is still very low, with no deaths and only one severe case,  the criteria is also now met because it is a new virus, therefore  many unknowns remain. The fundamental reason that the director general cites is important – and this is the requirement this places on global cooperation, and the need to support less well-resourced countries.

“This Global cooperation was already happening and was in action as soon as the first reports were released. The world has truly learnt from the recent experiences with Ebola, Zika and previous coronavirus outbreaks (MERS and SARS) have resulted in strong networks, systems and plans that are functioning and already making remarkable progress. The Chinese have shared their case reports and the released the genome of the virus. This has allowed for rapid development of accurate diagnostic tests and unprecedented speed in  developing potential vaccines. There are many international advisory boards, committees and organisations in place, continually working together in order to respond to these very situations. This is encouraging and should serve to address the many unknowns, limit transmission and accelerate the development of accurate diagnostics that can be used in the most remote places and indeed vaccines which could ultimately halt the disease. Key here will be the willingness to share research methods, data and standards in order that the fastest possible progress can be made, and that solutions identified, such as diagnostic tools, treatments, and vaccines are developed within global partnerships and appropriate for use in every context across the globe.”

 

Prof Christl Donnelly, Imperial College London and University of Oxford, said:

The term Public Health Emergency of International Concern (PHEIC) was defined in International Health Regulations in 2005.  Previous PHEIC declarations have been made five times.  The emergencies were pandemic influenza in 2009, polio in 2014, Zika in 2016 and Ebola in 2014 and 2019.  When Ebola in West Africa was declared a PHEIC in August 2014, that was the first time that there were two PHEICs at the same time with polio having been declared a PHEIC in May 2014. One of the requirements of a PHEIC is that it is determined “to potentially require a coordinated international response”. The Emergency Committee made clear that further internationally exported cases are anticipated and that they may arise in any country.”

 

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

“This decision is not unexpected, given reports of person to person transmission outside of China.

This announcement helps the world scientific community outside of China to prepare, by giving financial and time resources, also making it easier to share reagents and samples.

“While China is making huge efforts to contain the virus and the worldwide scientific community has now been mobilised, it is looking possible that this virus will establish itself worldwide.

“We will then need to move to the next stage of seeking treatment or prevention (such as a vaccine) and targeting those most at risk of severe disease.

I suspect that this will follow a similar course to pandemic Influenza in 2009 announcement, which while being a major problem for healthcare facilities worldwide, did not become the complete nightmare of a 1918 influenza pandemic.  

“However, I say that on too little evidence. We need more data on mild and potentially asymptomatic cases and also how the virus will behave in an environment where it can potentially spread faster than China (where quarantine may be less effective) before we can be confident to be sure of that.”

 

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said: 

“It is unsurprising that this time the WHO did declare the coronavirus outbreak a PHEIC. They were reportedly close to calling it last time, so given there are more cases and more countries with confirmed cases, that has probably tipped the balance.

“This is likely more a symbolic and political gesture, as it is hard to see what extra resource could be applied to addressing the outbreak in China that has not already been available. However, this declaration may make it easier to access and mobilise further funds for resource-poor countries, and promote the need for further global cooperation. For example, previous PHEICs were declared during the Ebola outbreak in West Africa, and the emergence of Zika virus in South America. The common theme between all of them is the uncertainty as to what will happen next.”

 

Prof Devi Sridhar, Chair and Professor of Global Public Health at the University of Edinburgh Medical School, said: 

“I think this decision was long overdue. As Dr. Tedros said, the real worry is the virus spreading in countries with weak health systems which are not prepared for containing outbreaks. It is still largely a Chinese emergency- 99% of cases are in China, and all 170 deaths in China. And the benefit of now having the PHEIC is cohesion about the seriousness of this virus, and ensuring that there is acceleration in a vaccine, therapeutics and diagnostics.’ 

 

Dr Jeremy Farrar, Director of Wellcome, said: 

“It is absolutely right to have declared a Public Health Emergency of International Concern.

“Countries, public health teams and researchers worldwide have been acting on this with the very highest level of concern for the last few weeks. But this virus has spread at unprecedented scale and speed, with cases passing between people in multiple countries across the world.   

“Declaration of an international emergency will undoubtedly sharpen governments’ focus on protecting citizens. But we must also step-up as an international community to make sure no one is left behind – with all interventions, including public health measures, diagnostics, treatments and vaccines available to everyone.  This will challenge the best resourced countries  but will have disproportionate impact on fragile health systems in low and middle income countries. 

“The virus is certainly spreading person-to-person in those with mild symptoms and possibly in those very early in illness with no symptoms. This makes it extremely challenging to control, and we do not have proven treatments or vaccines. A global epidemic of a rapid-spreading novel respiratory virus like this, which has crossed from animals to humans, is something warned of for many years. It is also a stark reminder of how vulnerable we are to epidemics of infectious diseases known and unknown.

“Accelerating research, with all data promptly shared through the WHO, is key to saving lives and ending this epidemic. But while clinicians, public health communities and researchers globally continue to work tirelessly to address the many uncertainties and unknowns, robust public health measures are critical.

“Vaccine, treatment and diagnostics trials are underway, but will take time. These need international support and funding. We also need urgently to determine how long people are infectious, how the virus transmits, who is most at risk – as well as ensuring the best caring for all affected. 

“We must commend China for its response, and its commitment to the health of its citizens and the world. The nurses, doctors and other health care workers caring for their patients and communities in difficult and often frightening circumstances deserve all our thanks and support.

“We must all take this very seriously, use the best available evidence to inform policy, be open about uncertainties and support the public health authorities and healthcare workers working non-stop and in very challenging conditions to keep us all safe.”

 

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/tag/wuhan-coronavirus/

 

Declared interests

None received. 

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