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Infectious Diseases

Updated 13 March 2020

Coronavirus - When should an outbreak be classified as a global emergency?

In a statement, the World Health Organization admitted they made a mistake by underestimating the severity of the coronavirus - but when is an outbreak truly a global emergency?

Following the news that the first case of novel coronavirus has just been confirmed in Ivory Coast, Africa, we are probably panicking and wondering why this latest strain of the coronavirus from Wuhan is not being taken seriously enough by authorities. 

A week ago, on Wednesday, January 22, the World Health Organization's meeting in Geneva was postponed after "more information was needed on the matter".

But after the latest developments, in a statement, the World Health Organization has admitted to mking an error in its assessment of the coronavirus risk. A situation report from the Geneva-based UN agency stated on Sunday 26 January 2020 that the risk was “very high in China, high at the regional level and high at the global level”.

The WHO stated that its previous statement that the virus was "moderate" was “incorrect”.

However, this still doesn’t mean that a global emergency has been declared by the WHO. The term “global emergency” is a term only used on rare occasions – five times in the past.

But in the case of the new coronavirus, which has already infected more than 2 000 people in several countries and caused the death of 81 Chinese residents, what exactly counts as a global emergency and when is it declared?

You might wonder how many people must succumb to a deadly illness before the WHO declares a global emergency, but the organisation emphasised that this term can’t be used lightly. Tedros Adhanom Ghebreyesus, director general of the World Health Organization (WHO), explained the situation at their latest press conference.

What exactly is a 'global emergency' and when is it declared?

According to the WHO, the first time the concept of a global emergency came up, was in 2003 when severe acute respiratory syndrome (SARS), also an illness caused by a coronavirus, broke out.

But, in the case of SARS, the outbreak had already been causing illness and deaths for many months before Chinese authorities took more extreme measures.

A “global emergency” is formally known as a Public Health Emergency of International Concern (PHEIC), and defined by the WHO 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”.

But it was only after the SARS outbreak that PHEIC was introduced as a concept. According to the WHO, the International Health Regulations Act of 1969 was introduced to help monitor and control only cholera, plague and yellow fever.

PHEIC was, however, declared under the International Health Regulations Act of 2005 to manage situations and outbreaks and make provision for new strains of viruses, such as SARS. Where the Act of 1969 made provision to quarantine cases of illness, the updated Act of 2005 worked at containing the outbreak at the source and ensuring that other countries take the necessary measures to help contain any cases of the outbreak.

Now, an outbreak is declared as a “global emergency” or PHEIC when  “an extraordinary event which is determined … to constitute a public health risk to other states through the international spread of disease”.

What makes the outbreak of novel coronavirus less severe on a global scale in this case?

According to Tedros, declaring a global emergency can have an unnecessary impact on factors such as trade and tourism and imply that a country is unable to control a disease on its own. Tedros also praised China for spotting the virus quickly enough and for sharing vital information with the rest of the world.

Scientists need to determine how quickly the virus spreads (in the case of the novel coronavirus, rather rapidly) and also how severe the disease is. As of 26 January, 2.8% of the 2014 confirmed cases were fatal, while the SARS percentage was much higher at 10%.

Still a serious matter, even without a global emergency

But Tedros says that even though a state of global emergency hasn’t been declared yet, it doesn’t mean that the severity of the matter is not being attended to. He states that there is a coordinated effort by various countries to help contain the outbreak.

A new strain of virus is always cause for concern and always needs to be announced, and hopefully the world has learned from the 2003 SARS outbreak.

When did we have global emergencies?

To date, only five instances of PHEIC have been announced. These were:

1. The 2009 H1N1 virus (swine flu)

The 2009 version of this flu originated in pigs in a region of Mexico. According to a study published in The Lancet – Infectious Diseases,  there were about 18 500 laboratory-confirmed H1N1-related deaths between 2009 and 2010, which is likely to be only a fraction of the true number of deaths caused by this virus.

2. Polio in 2014

After years of complete eradication of the polio virus, the WHO declared it a global emergency in May 2014 after it had spread from Pakistan to several countries in Africa and the Middle East.

3. Ebola in 2014

The deadly virus that can cause severe haemorrhaging was declared a global emergency in August 2014.  

4. Zika virus in 2016

This virus, transmitted by mosquitoes, was declared a global emergency in 2016 after concerns that the unknown viral infection caused side-effects such as birth defects in pregnant women.

5. Kivu Ebola outbreak in 2018

The most recent Ebola outbreak occurred in August 2018 in North Kivu, a province in the Democratic Republic of the Congo, but was only declared a global emergency a year later in 2019 after becoming the biggest outbreak of Ebola in the DRC’s history.

Image credit: Unsplash/Tam Wai