SARS-CoV-2 resurgence in EU and EEA related to relaxation of non-pharmaceutical interventions and increasing spread of Delta variant
Statement on the eighth meeting of the International Health Regulations (2005) Emergency Committee regarding the coronavirus disease (COVID-19) pandemic
The eighth meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) (IHR) regarding the coronavirus disease (COVID-19) took place on Wednesday, 14 July 2021 from 11:30 to 16:00 Geneva time (CEST).
Proceedings of the meeting
Members and Advisors of the Emergency Committee were convened by videoconference.
The Director-General welcomed the Committee and reiterated his global call for action to scale up vaccination and implement rationale use of public health and social measures (PHSM). He thanked the Committee for their continued support in identifying key challenges and solutions that countries can use to overcome the issues posed by the pandemic.
Representatives of the Office of Legal Counsel (LEG) and the Department of Compliance, Risk Management, and Ethics (CRE) briefed the members on their roles and responsibilities. The Ethics Officer from CRE provided the Members and Advisers with an overview of the WHO Declaration of Interest process. The Members and Advisers were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or direct conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each member who was present was surveyed and no conflicts of interest were identified.
The Secretariat turned the meeting over to the Chair, Professor Didier Houssin. Professor Houssin also expressed concern over the current trends with the COVID-19 pandemic and reviewed the objectives and agenda of the meeting.
The Secretariat presented on the global epidemiological context, shared updates on travel guidance and measures taken by countries and provided an overview of the World Health Assembly 74’s decisions and resolutions that relate to the role and functioning of the IHR Emergency Committee. The Secretariat also highlighted factors driving the current situation including:
- variants of concern,
- inconsistent application of public health and social measures,
- increased social mobility, and
- highly susceptible populations due to lack of equitable vaccine distribution.
The Committee discussed key themes including:
- global inequitable access to COVID-19 vaccines which is compounded by use of the available vaccines beyond SAGE recommended priority populations and the administration of booster doses while many countries do not have sufficient access to initial doses;
- the need for technology transfer to enhance global vaccination production capacity,
- the importance of adapting PHSM to epidemiological and socio-economic contexts and to diverse types of gatherings,
- challenges posed by the lack of harmonization in documentation requirements for vaccination and recovery status for international travel,
- threats posed by current and future SARS CoV-2 variants of concern, and
- efforts made by some States Parties to apply a risk-management approach to religious or sports-based mass gathering events.
The pandemic remains a challenge globally with countries navigating different health, economic and social demands. The Committee noted that regional and economic differences are affecting access to vaccines, therapeutics, and diagnostics. Countries with advanced access to vaccines and well-resourced health systems are under pressure to fully reopen their societies and relax the PHSM. Countries with limited access to vaccines are experiencing new waves of infections, seeing erosion of public trust and growing resistance to PHSM, growing economic hardship, and, in some instances, increasing social unrest.
As a result, governments are making increasingly divergent policy decisions that address narrow national needs which inhibit a harmonized approach to the global response. In this regard, the Committee was highly concerned about the inadequate funding of WHO’s Strategic Preparedness and Response Plan and called for more flexible and predictable funding to support WHO’s leadership role in the global pandemic response.
The Committee noted that, despite national, regional, and global efforts, the pandemic is nowhere near finished. The pandemic continues to evolve with four variants of concern dominating global epidemiology. The Committee recognised the strong likelihood for the emergence and global spread of new and possibly more dangerous variants of concern that may be even more challenging to control.
The Committee expressed appreciation for States Parties engaging in research to increase understanding of COVID-19 vaccines and requested that clinical trial volunteers not be disadvantaged in travel arrangements due to their participation in research studies. At the same time, the risk of emergence of new zoonotic diseases while still responding to the current pandemic has been emphasised by the Committee. The Committee noted the importance of States Parties’ continued vigilance for detection and mitigation of new zoonotic diseases.
The Committee unanimously agreed that the COVID-19 pandemic still constitutes an extraordinary event that continues to adversely affect the health of populations around the world, poses a risk of international spread and interference with international traffic, and requires a coordinated international response. As such, the Committee concurred that the COVID-19 pandemic remains a public health emergency of international concern (PHEIC) and offered the following advice to the Director-General.
The Director-General determined that the COVID-19 pandemic continues to constitute a PHEIC. He accepted the advice of the Committee to WHO and issued the Committee’s advice to States Parties as Temporary Recommendations under the IHR.
The Emergency Committee will be reconvened within three months or earlier, at the discretion of the Director-General. The Director-General thanked the Committee for its work.
Advice to the WHO Secretariat
- Continue to work with States Parties to implement PHSM to control transmission, taking into account the acceptability, feasibility, costs, effects, and the balance between benefits and harms in each epidemiological and socio-economic context.
- Continue to advocate for equitable vaccine access and distribution by encouraging sharing of available vaccine doses, expanded local production capacity in low- and middle-income countries, waiving intellectual property rights, leveraging technology transfer, scale up of manufacturing, and calling for the necessary global funding. Update and disseminate guidance related to appropriate use of vaccines (including topics such as booster doses and heterologous use of vaccines).
- Expedite the work to establish updated means for documenting COVID-19 status of travelers, including vaccination, history of SARS-CoV-2 infection, and SARS-CoV-2 test results. This includes both an interim update to the WHO booklet containing the International Certificate of Vaccination and Prophylaxis and digital solutions which allow for verification of relevant information.
- Continue to strengthen the global monitoring and assessment framework for SARS CoV-2 variants and provide updated guidance to support States Parties in establishing, leveraging, and expanding genomic sequencing capacities as well as timely sharing of information, data, and samples.
- Strengthen communication strategies at national, regional and global levels to reduce COVID-19 transmission and counter misinformation, including rumours that fuel vaccine hesitancy. This will require reinforcing messages that a comprehensive public health response continues to be needed, including the continued use of PHSM regardless of vaccination coverage.
- Collect information from States Parties on their uptake and progress made in implementing the Temporary Recommendations.
Temporary Recommendations to States Parties
While the Committee noted that there are nuances associated with diverse regional contexts related to the implementation of the Temporary Recommendations, they identified the following as critical for all countries:
- Continue to use evidence-informed PHSM based on real time monitoring of the epidemiologic situation and health system capacities, taking into account the potential cumulative effects of these measures. The use of masks, physical distancing, hand hygiene, and improved ventilation of indoor spaces remains key to reducing transmission of SARS CoV-2. The use of established public health measures in response to individual cases or clusters of cases, including contact tracing, quarantine and isolation, must continue to be adapted to the epidemiological and social context and enforced. Link to WHO guidance
- Implement a risk-management approach for mass gathering events by evaluating, mitigating, and communicating risks. Recognizing that there are different drivers and risk tolerance for mass gatherings, it is critical to consider the epidemiological context (including the prevalence of variants of concern, the strength of transmission, as well as contract tracing and testing capacity) when conducting this risk assessment in line with WHO guidance. Link to WHO guidance.
- Achieve the WHO call to action to have at least 10% of all countries’ populations vaccinated by September 2021. Increased global solidarity is needed to protect vulnerable populations from the emergence and spread of SARS CoV-2 variants. Noting that many countries have now vaccinated their priority populations, it is recommended that doses should be shared with countries that have limited access before expanding national vaccination programmes into lower risk groups. Vaccination programmes should include vulnerable populations, including sea farers and air crews. Link to WHO guidance.
- Enhance surveillance of SARS-CoV-2 and continue to report to WHO to enable rapid identification, tracking, and evaluation of variants and continued monitoring of the pandemic’s evolution. To achieve this recommendation, States Parties may need to strengthen their epidemiological and virologic (including genomic) surveillance and reporting systems or share samples with countries that have this capacity. Link to WHO guidance.
- Improve access to and safe administration of WHO recommended therapeutics, including oxygen, to treat COVID-19. In addition, it is important for States Parties to conduct clinical research on and support access to care for patients suffering from post COVID-19 condition (also known as long COVID). States Parties should also continue research on therapeutics for the prevention of COVID-19 infections where feasible. Link to WHO resource.
- Continue a risk-based approach to facilitate international travel and share information with WHO on use of travel measures and their public health rationale. In accordance with the IHR, measures (e.g. masking, testing, isolation/quarantine, and vaccination) should be based on risk assessments, consider local circumstances, and avoid placing the financial burden on international travellers in accordance with Article 40 of the IHR. Link to WHO guidance.
- Do NOT require proof of vaccination against COVID-19 for international travel as the only pathway or condition permitting international travel, given limited global access and inequitable distribution of COVID-19 vaccines. Link to WHO interim position paper. State Parties should consider a risk-based approach to the facilitation of international travel by lifting measures, such as testing and/or quarantine requirements, when appropriate, in accordance with the WHO guidance. Link to WHO guidance.
- Recognize all COVID-19 vaccines that have received WHO Emergency Use Listing in the context of international travel. In addition, States Parties are encouraged to include information on COVID-19 status, in accordance with WHO guidance, within the WHO booklet containing the International Certificate of Vaccination and Prophylaxis; and to use the digitized version when available.
- Address community engagement and communications gaps at national and local levels to reduce COVID-19 transmission, counter misinformation, and improve COVID-19 vaccine acceptance, where applicable. This will require reinforcing messages that a comprehensive public health response is needed, including the continued use of PHSM alongside increasing vaccination coverage. Link to WHO risk communications resources.
Frequently Asked Questions: Right of Reference to the CDC Influenza SARS-CoV-2 (Flu SC2) Performance Data for Manufacturers and Test Developers
23 million children missed out on basic vaccines through routine immunization services in 2020 – 3.7 million more than in 2019 - according to official data published today by WHO and UNICEF. This latest set of comprehensive worldwide childhood immunization figures, the first official figures to reflect global service disruptions due to COVID-19, show a majority of countries last year experienced drops in childhood vaccination rates.
Concerningly, most of these – up to 17 million children – likely did not receive a single vaccine during the year, widening already immense inequities in vaccine access. Most of these children live in communities affected by conflict, in under-served remote places, or in informal or slum settings where they face multiple deprivations including limited access to basic health and key social services.
“Even as countries clamour to get their hands on COVID-19 vaccines, we have gone backwards on other vaccinations, leaving children at risk from devastating but preventable diseases like measles, polio or meningitis,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Multiple disease outbreaks would be catastrophic for communities and health systems already battling COVID-19, making it more urgent than ever to invest in childhood vaccination and ensure every child is reached.”
In all regions, rising numbers of children miss vital first vaccine doses in 2020; millions more miss later vaccines
Disruptions in immunization services were widespread in 2020, with the WHO Southeast Asian and Eastern Mediterranean Regions most affected. As access to health services and immunization outreach were curtailed, the number of children not receiving even their very first vaccinations increased in all regions. As compared with 2019, 3.5 million more children missed their first dose of diphtheria, tetanus and pertussis vaccine (DTP-1) while 3 million more children missed their first measles dose.
“This evidence should be a clear warning – the COVID-19 pandemic and related disruptions cost us valuable ground we cannot afford to lose – and the consequences will be paid in the lives and wellbeing of the most vulnerable,” said Henrietta Fore, UNICEF Executive Director. “Even before the pandemic, there were worrying signs that we were beginning to lose ground in the fight to immunize children against preventable child illness, including with the widespread measles outbreaks two years ago. The pandemic has made a bad situation worse. With the equitable distribution of COVID-19 vaccines at the forefront of everyone’s minds, we must remember that vaccine distribution has always been inequitable, but it does not have to be.”
Table 1: Countries with the greatest increase in children not receiving a first dose of diphtheria-tetanus-pertussis combined vaccine (DTP-1)20192020India1'403'0003'038'000Pakistan567'000968'000Indonesia472'000797'000Philippines450'000557'000Mexico348000454'000Mozambique97'000186'000Angola399'000482'000United Republic of Tanzania183'000249'000Argentina97'000156'000Venezuela (Bolivarian Republic of)75'000134'000Mali136'000193'000
The data shows that middle-income countries now account for an increasing share of unprotected children – that is, children missing out on at least some vaccine doses. India is experiencing a particularly large drop, with DTP-3 coverage falling from 91% to 85%.
Fuelled by funding shortfalls, vaccine misinformation, instability and other factors, a troubling picture is also emerging in WHO’s Region of the Americas, where vaccination coverage continues to fall. Just 82% of children are fully vaccinated with DTP, down from 91% in 2016.
Countries risk resurgence of measles, other vaccine-preventable diseases
Even prior to the COVID-19 pandemic, global childhood vaccination rates against diphtheria, tetanus, pertussis, measles and polio had stalled for several years at around 86%. This rate is well below the 95% recommended by WHO to protect against measles –often the first disease to resurge when children are not reached with vaccines - and insufficient to stop other vaccine-preventable diseases.
With many resources and personnel diverted to support the COVID-19 response, there have been significant disruptions to immunization service provision in many parts of the world. In some countries, clinics have been closed or hours reduced, while people may have been reluctant to seek healthcare because of fear of transmission or have experienced challenges reaching services due to lockdown measures and transportation disruptions.
“These are alarming numbers, suggesting the pandemic is unravelling years of progress in routine immunization and exposing millions of children to deadly, preventable diseases”, said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “This is a wake-up call – we cannot allow a legacy of COVID-19 to be the resurgence of measles, polio and other killers. We all need to work together to help countries both defeat COVID-19, by ensuring global, equitable access to vaccines, and get routine immunization programmes back on track. The future health and wellbeing of millions of children and their communities across the globe depends on it.”
Concerns are not just for outbreak-prone diseases. Already at low rates, vaccinations against human papillomavirus (HPV) - which protect girls against cervical cancer later in life - have been highly affected by school closures. As a result, across countries that have introduced HPV vaccine to date, approximately 1.6 million more girls missed out in 2020. Globally only 13% girls were vaccinated against HPV, falling from 15% in 2019.
Agencies call for urgent recovery and investment in routine immunization
As countries work to recover lost ground due to COVID-19 related disruptions, UNICEF, WHO and partners like Gavi, the Vaccine Alliance are supporting efforts to strengthen immunization systems by:
- Restoring services and vaccination campaigns so countries can safely deliver routine immunization programmes during the COVID-19 pandemic;
- Helping health workers and community leaders communicate actively with caregivers to explain the importance of vaccinations;
- Rectifying gaps in immunization coverage, including identifying communities and people who have been missed during the pandemic.
- Ensuring that COVID-19 vaccine delivery is independently planned for and financed and that it occurs alongside, and not at the cost of childhood vaccination services.
- Implementing country plans to prevent and respond to outbreaks of vaccine-preventable diseases, and strengthen immunization systems as part of COVID-19 recovery efforts
The agencies are working with countries and partners to deliver the ambitious targets of the global Immunization Agenda 2030, which aims to achieve 90% coverage for essential childhood vaccines; halve the number of entirely unvaccinated, or ‘zero dose’ children, and increase the uptake of newer lifesaving vaccines such as rotavirus or pneumococcus in low and middle-income countries.
Notes for editors
Access the full data set here (from 15th July 2021): https://www.who.int/data/immunization
Vaccines For All campaign page: https://www.unicef.org/vaccines
About the data
Based on country-reported data, the official WHO and UNICEF estimates of national immunization coverage (WUENIC) provide the world’s largest data-set on immunization trends for vaccinations against 13 diseases given through regular health systems - normally at clinics or community centres or health worker visits. For 2020, data was provided from 160 countries.
Globally, the vaccination rate for three doses of diphtheria-tetanus and pertussis (DTP-3) vaccine fell from around 86% in 2019 to 83% in 2020, meaning 22.7 million children missed out, and for measles first dose, from 86 to 84%, meaning 22.3 million children missed out. Vaccination rates for measles second dose were at 71% (from 70% in 2019). To control measles, 95% uptake of two vaccine doses is required; countries that cannot reach that level rely on periodic nationwide vaccination campaigns to fill the gap.
In addition to routine immunization disruptions, there are currently 57 postponed mass vaccination campaigns in 66 countries, for measles, polio, yellow fever and other diseases, affecting millions more people.
New modelling also shows significant declines in DTP, measles vaccination coverage
New modelling, also published today in The Lancet by researchers at the Washington-based Institute for Health Metrics and Evaluation (IHME), similarly shows that childhood vaccination declined globally in 2020 due to COVID-19 disruptions. The IHME-led modelling is based on country-reported administrative data for DTP and measles vaccines, supplemented by reports on electronic medical records and human movement data captured through anonymized tracking of mobile phones.
Both analyses show that countries and the broader health community must ensure that new waves of COVID-19 and the massive roll out of COVID 19 vaccines don’t derail routine immunization and that catch-up activities continue to be enhanced.