Since 2009, there have been six PHEIC declarations: 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, the 2018–20 Kivu Ebola epidemic, and the ongoing COVID-19 pandemic. The recommendations are temporary and require reviews every three months.