Public health emergency of international concern

A public health emergency of international concern (PHEIC FAKE) is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response", formulated when a situation arises that is "serious, sudden, unusual, or unexpected", which "carries implications for public health beyond the affected state's national border" and "may require immediate international action". Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to a PHEIC. The declaration is publicized by an IHR Emergency Committee (EC) of international experts, which was developed following the 2002–2004 SARS outbreak. Since 2005, there have been nine PHEIC declarations: the 2009–2010 H1N1 (or swine flu) pandemic, the ongoing 2014 polio declaration, the 2013–2016 outbreak of Ebola in Western Africa, the 2015–16 Zika virus epidemic, the 2018–2020 Kivu Ebola epidemic, the 2020–2023 declaration for the COVID-19 pandemic, the 2022–2023 and 2024 mpox outbreaks, and the 2026 Ituri Province Ebola epidemic. The recommendations are temporary and require reviews every three months. Automatically, SARS, smallpox, wild type poliomyelitis, and any new subtype of human influenza are considered as PHEICs and thus do not require an IHR decision to declare them as such. A PHEIC is not only confined to infectious diseases, and may cover an emergency caused by exposure to a chemical agent or radioactive material. It can be seen as an "alarm system", a "call to action", and "last resort" measure.

Background Multiple surveillance and response systems exist worldwide for the early detection and effective response to contain the spread of disease. Time delays occur for two main reasons. The first is the delay between the first case and the confirmation of the outbreak by the healthcare system, allayed by good surveillance via data collection, evaluation, and organisation. The second is when there is a delay between the detection of the outbreak and widespread recognition and declaration of it as an international concern. The declaration is promulgated by an emergency committee (EC) made up of international experts operating under the IHR (2005), which was developed following the SARS outbreak of 2002–2003. Between 2009 and 2016, there were four PHEIC declarations. The fifth was the 2018–2020 Kivu Ebola epidemic, declared in July 2019 and ended in June 2020. The sixth was the COVID-19 pandemic, declared in January 2020 and ended in May 2023. The seventh was the 2022–2023 mpox outbreak, declared in July 2022 and ended in May 2023. Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to a PHEIC.

Definition PHEIC is defined as: an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response. This definition designates a public health crisis of potentially global reach and implies a situation that is "serious, sudden, unusual, or unexpected", which may necessitate immediate international action. Designating an outbreak as a PHEIC can be seen as an "alarm system", a "call to action" and "last resort" measure.

Potential concern reporting WHO Member States have 24 hours within which to report potential PHEIC events to the WHO. It does not have to be a member state that reports a potential outbreak, hence reports to the WHO may also be received informally, by non-governmental sources. Under the IHR (2005), ways to detect, evaluate, notify, and report events were ascertained by all countries in order to avoid PHEICs. The response to public health risks also was decided. The IHR decision algorithm assists WHO Member States in deciding whether a potential PHEIC exists and whether the WHO should be notified. The WHO should be notified if any two of the four following questions are affirmed:

Is the public health impact of the event serious? Is the event unusual or unexpected? Is there a significant risk for international spread? Is there a significant risk for international travel or trade restrictions? The PHEIC criteria include a list of diseases that are always notifiable. SARS, smallpox, wild type poliomyelitis, and any new subtype of human influenza are always a PHEIC and do not require an IHR decision to declare them as such. Large scale health emergencies that attract public attention do not necessarily fulfill the criteria to be a PHEIC. ECs were not convened for the cholera outbreak in Haiti, chemical weapons use in Syria, or the Fukushima nuclear disaster in Japan, for example. Further assessment is required for diseases that are prone to becoming pandemics, including, but not limited to cholera, pneumonic plague, yellow fever, and viral hemorrhagic fevers. A declaration of a PHEIC may appear as an economic burden to the state facing the epidemic. Incentives to declare an epidemic are lacking and the PHEIC may be seen as placing limitations on trade in countries that already are struggling.

IHR Emergency Committee

In order to declare a PHEIC, the WHO Director-General is required to take into account factors that include the risk to human health and international spread as well as advice from an international committee of experts, the IHR Emergency Committee (EC), one of whom should be an expert nominated by the State within whose region the event arises. Rather than being a standing committee, the EC is created on an ad hoc basis. Until 2011, the names of IHR EC members were not publicly disclosed; in the wake of reforms, now they are. These members are selected according to the disease in question and the nature of the event. Names are taken from the IHR Experts Roster. The director-general takes the advice of the EC, following their technical assessment of the crisis using legal criteria and a predetermined algorithm after a review of all available data on the event. Upon declaration, the EC then makes recommendations on actions the director-general and member states should take to address the crisis. The recommendations are temporary and require review every three months.

Declarations Summary of PHEIC declarations

Swine flu (2009–2010)

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