The WHO ends the COVID-19 emergency, and the pandemic accord is still a draft

On Friday 5 May 2023 the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, concurred with the advice of the Emergency Committee convened under the International Health Regulations (2005) and determined that COVID-19 "no longer constitutes a public health emergency of international concern". The Committee had met the day before, on 4 May, and had recorded a decreasing trend in deaths and a high level of population immunity. The Director-General described the disease as an established and ongoing health issue[1]. He had declared the emergency on 30 January 2020, when fewer than 10,000 cases had been reported, most of them in China[2].

The end of the emergency is a legal act, and we take it as one. Under the International Health Regulations (2005), a public health emergency of international concern is a determination made by the Director-General on the advice of the Emergency Committee, and it carries temporary recommendations to States Parties. The determination has now been withdrawn. The temporary recommendations have not disappeared with it. The Director-General issued a new set of seven on 5 May. They ask States Parties to sustain the capacities built during the pandemic, to integrate COVID-19 vaccination into life course programmes, to bring together respiratory pathogen surveillance, to keep lifting international travel measures without requiring proof of vaccination, and to continue supporting research. The Director-General also announced that he would convene an IHR Review Committee to advise on standing recommendations for the long-term management of SARS-CoV-2[1].

Three years in figures

The figures published alongside the decision describe the pandemic our generation lived through. Nearly seven million deaths have been reported to the WHO. Tedros said that the true total is "several times higher, at least 20 million"[2]. The Committee noted that 13.3 billion vaccine doses have been administered worldwide, that 89 per cent of health workers have completed a primary series and that 82 per cent of adults over 60 have done so[1]. Those figures are an achievement. They are also an average, and the average hides the gap between the countries that vaccinated early and the countries that waited.

The cost for young Europeans was paid in a different currency. Eurofound's e-survey of March to May 2022 found that mental well-being across the European Union averaged 47 on the WHO-5 scale, below the threshold of 50 at which a respondent is considered at risk of depression and below the 49 recorded at the start of the pandemic. Eurofound wrote of "the alarmingly high number of respondents in the youngest age group (18-24)"[3]. The emergency has ended for the International Health Regulations. It has not ended for the people who spent their last years of school or their first years of work behind a screen.

The accord that does not yet exist

The second half of this story is in Geneva. In December 2021 the World Health Assembly, meeting in special session, agreed to establish an Intergovernmental Negotiating Body to draft a "WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response". The Body is to submit its outcome to the Seventy-seventh World Health Assembly in 2024[4]. The European Union is a party to that process. Council Decision (EU) 2022/451 of 3 March 2022 authorised the opening of negotiations on behalf of the Union on an international agreement on pandemic prevention, preparedness and response, together with complementary amendments to the International Health Regulations (2005)[5].

The fifth meeting of the Negotiating Body took place in Geneva from 3 to 6 April 2023 and worked on the zero draft in a Drafting Group that met in closed session[6]. The outcome was procedural. Countries agreed to accept further written proposals until 22 April 2023. The Bureau is to provide a Bureau's Text, including options where feasible, by 22 May 2023, and the Drafting Group is to meet again in June. The negotiations run in parallel with more than 300 proposed amendments to the International Health Regulations (2005), and both texts are meant to reach the Assembly in May 2024. The co-chair Roland Driece said that the aim is "an accord that will help us not to repeat the mistakes"[7].

We read those dates with some impatience. The emergency has ended before the instrument designed to prevent the next one has a negotiated text. The hard questions are known. Who gets access to pathogen samples and sequences, and what do they owe in return? Who pays for surveillance in countries that cannot? Who decides, in the first weeks, whether vaccines go to the highest bidder or to the highest risk? None of those questions has an agreed answer in the zero draft, and the Bureau's Text due on 22 May will be the first occasion to see whether the options narrow.

Our generation has a direct interest in the answer. We were the age group with the least to fear from the virus and the most to lose from the closures, and we accepted the closures. The accord is the one instrument that could make the next set of closures shorter, because faster sharing of pathogens and faster production of countermeasures shortens the period in which closures are the only tool.

We recommend that the Union, through the mandate in Council Decision (EU) 2022/451, support binding provisions on pathogen access and benefit sharing in the Bureau's Text, because voluntary sharing is what the world had in January 2020. We recommend that Member States keep the Emergency Committee's temporary recommendations in force domestically until the IHR Review Committee has delivered standing recommendations, so that surveillance capacity is not dismantled in the gap. We recommend that the Commission ask Eurofound to repeat its mental well-being survey in 2023 and to publish the results by age group before the European elections of 2024, so that the cost borne by the youngest age group is measured. We recommend that the Negotiating Body open the Drafting Group sessions of June 2023 to webcast, as the opening and closing sessions already are, because an accord negotiated in closed session will be harder to defend to the people it is meant to protect.