What next for the coronavirus response?
Authors: John Zarocostas
Journal: The Lancet (2020)

The novel coronavirus outbreak centred in China has been declared a public health emergency of international concern. What now? John Zarocostas reports from Geneva. The decision by WHO Director-General Tedros Adhanom Ghebreyesus to declare on Jan 30 the novel coronavirus (2019-nCoV) outbreak a public health emergency of international concern (PHEIC) is expected to intensify global preparedness and response efforts. However, the declaration is likely to test the resilience of the 2005 International Health Regulations, in light of measures introduced by many countries that appear to differ from WHO's temporary recommendation not to limit travel and trade. Didier Houssin, chair of the Emergency Committee that advised Dr Tedros, said in a press conference that the committee “almost unanimously concluded” it was time to recommend declaring a PHEIC, “considering first, the increase in the number of cases in China; second, the increase in the number of countries affected with cases; and also that some countries have taken questionable measures concerning travellers”. At its first meeting, a week before, the committee was split on whether to recommend a PHEIC. Tedros was careful to clarify that the announcement was not a criticism of China, saying that the main reason for the PHEIC declaration “is not because of what is happening in China, but because of what is happening in other countries. Our greatest concern is the potential for the virus to spread to countries with weaker health systems, and which are ill prepared to deal with it”. Chen Xu, China's ambassador to the UN in Geneva, told reporters the declaration is “what the WHO needed to do and was within its duty…The PHEIC and the recommendations will be conducive to have more coordinated actions”. He noted that most people in China and around the world “have no idea what is PHEIC. People need some time to digest”. Tarik Jasarevic, a WHO spokesperson, told The Lancet that issuing a PHEIC generally has three effects. First, WHO issues temporary recommendations; these are non-binding but practically and politically significant measures that can address travel, trade, quarantine, screening, and treatment, setting global standards of practice. Second, WHO can hold countries to account when they needlessly exceed these global standards. Third, a PHEIC enhances coordination, cooperation, and global solidarity. Takeshi Kasai, regional director of WHO's regional office for the Western Pacific, which includes China, told The Lancet that strengthening preparedness and building capacity might prove more challenging for countries with few resources, saying that “some countries may need to repurpose existing resources to support their preparedness efforts. WHO is ready to support countries in this work”. Among the recommendations in seven key areas, Dr Tedros underscored “first, there is no reason for measures that unnecessarily interfere with international travel and trade. WHO does not recommend limiting trade and movement”. Russia, Mongolia and North Korea have closed their land border with China, while Australia, New Zealand, the US, and others have banned entry for most travellers from China. Other recommendations are to support countries with weaker health systems; accelerate the development of vaccines, therapeutics, and diagnostics; combat the spread of rumours and misinformation; review preparedness plans; identify gaps and evaluate the resources needed to identify, isolate, and care for cases, and prevent transmission; share data, knowledge, and experience; and for countries to work together in a spirit of solidarity and cooperation. Health experts and emergency specialists believe the PHEIC will give focus to what needs to be done to contain the epidemic. Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University, told The Lancet that the PHEIC declaration “is an important political signal to the world and will hopefully provide WHO [with] the authority it needs to promote travel and trade advisories, or, in this case, engage with countries imposing travel restrictions on China when WHO has advised against such moves”. The global community will also look to WHO, Katz added, to “provide a single source of validated information on the outbreak”. Emanuele Capobianco, director for Health and Care at the International Federation of Red Cross and Red Crescent Societies, told The Lancet the determination of a PHEIC will also strengthen collaboration and shift “what may have been a response that was…until recently focused on the Asia-Pacific into an approach that is more global and more coordinated”. Jasarevic said that WHO is working with experts from the public and private sectors—including scientists, clinicians, disease trackers, and supply chain specialists—to coordinate the response, including providing biomedical and essential supplies for the management of 100 cases for vulnerable countries, accelerating access to therapeutics and vaccines, carrying out clinical trials, and conducting briefings with clinicians treating patients.