How have PHEIC determinations changed since the COVID-19 pandemic? A document analysis of 101 WHO International Health Regulations Emergency Committees' statements.

backgroundThe World Health Organization (WHO) is chiefly responsible for declaring a Public Health Emergency of International Concern (PHEIC). The WHO makes the assessment on whether to declare a formal PHEIC if the event fulfils three criteria: (i) it is an extraordinary event, (ii) is a public health risk to other States through the international spread of disease, and (iii) potentially requires a coordinated international response. There have been seven PHEIC declarations, including for the 2009 H1N1 flu pandemic, Ebola and Polio outbreaks, the COVID-19 pandemic, and most recently, the mpox outbreak. While the WHO's approach to PHEIC declarations prior to COVID-19 has been previously analyzed, there has been limited scholarly attention to how the approach has shifted since the pandemic. Given that COVID-19 constitutes the most severe pandemic in a century, this study empirically assesses how the PHEIC declaration process has been impacted by, and what has changed during and after, the COVID-19 pandemic.

methodA document analysis of 101 WHO International Health Regulations Emergency Committees' (EC) statements was undertaken with inductive thematic analysis. The thematic analysis focused on identifying common patterns in the EC statements to ascertain changes to PHEICs since COVID-19.

resultsThree primary themes emerged from our analysis: (i) this work affirms previous findings that the rationale for a PHEIC declaration and the criteria used to declare PHEICs have been applied inconsistently; (ii) since the COVID-19 pandemic, there has been a greater focus in explaining and justifying the use of the three criteria for PHEIC declarations and terminations; and (iii) since the COVID-19 pandemic, there has been increased detail, discussion, and structure in IHR EC statements. DISCUSSION: This analysis suggests that changes to the PHEIC process are needed and we present two primary recommendations: first, to create a new standardized interpretation of PHEIC criteria; and second, for the WHO EC to reaffirm its commitment to clear and transparent communications.

conclusionGiven changes to the PHEIC declaration process following the COVID-19 pandemic, it is evident that reforms are necessary to ensure a more consistent, transparent, and effective global health response moving forward. Our recommendations, if adopted, could significantly enhance the WHO's ability to respond to future global health crises, ensuring more consistent and transparent decision-making in PHEIC declarations, and ultimately strengthening international preparedness and cooperation.