Although the WHO have upheld the threat of COVID as a public health emergency of international concern, some in the general public do not maintain its state of urgency. The status of vaccine availability and eligibility has become unlinked with current regulations.

Vaccine booster rates are substandard in Australia with only about 44% uptake in eligible age brackets. However, some people seeking new bivalent boosters for 4th and 5th doses are denied access.

But the SARS-CoV2 is still evolving and new variants with mutations or recombinants emerge from Omicron. As world travel ramps up, it is only a matter of time before we find a new variant of concern. But are we keeping watch? Numbers of hospitalisations and deaths from COVID and immunity profiles of countries differ with waves of BA.4, BA.5 , BQ1.1 and XBB.

Our protective immune responses need a boost after waning but also broader coverage to combat the diverse array of spike mutations on the viruses and avoid post-viral complications (long COVID).  So, let’s sharpen our swords of immunity- still the best weapon against this disruptive and dangerous virus. 

Although the COVID-19 pandemic is not over, continuous endemic transmission is now established across much of the world and the last bastions of Covid-zero have now fallen.

Case numbers are still fluctuating dramatically, but this is an expected feature of endemic infections that confer short-lived immunity. In this context, the WHO’s approach of continuing the PHEIC in the short-term, but likely transitioning to a more sustainable, longer-term plan for Covid management soon, is appropriate and welcome.

Broad, population-wide immunity is the mainstay of our protection against the virus, and young healthy persons are no longer at high risk. Our approach to pandemic control should reflect this and focus on protecting vulnerable groups, rather than controlling transmission.

More importantly, now is the time to reflect on our pandemic experience to-date and to look ahead and think big about what we want for the future of public health. There has never been a better time to advocate for investing in pandemic preparedness, health care, medical research, air quality and social equity.

The decision by the WHO to extend the PHEIC is not unexpected and reflects both the recent waves driven by continued evolution of the SARS-CoV-2 virus and a desire to fully observe the effects of the omicron wave in China before determining that COVID-19 no longer meets PHEIC status.

So far, there is no evidence of new concerning variants from China and in the international context, newer variants such as XBB.1.5 have not been as problematic as initially predicted.

In fact, in the low and middle income countries that are the primary domain for WHO guidance and support, COVID has receded as a health burden, due largely to the high infection rates (and burden) across multiple previous waves, in general before high levels of vaccine uptake could be achieved.

As such, I expect that if China is more forthcoming with data and no new variants with dramatically different properties emerge that we will see the PHEIC status removed either at the April or July meetings of this committee.

One of the key measures to reduce the risk of infection transmission in public places, which is adequate ventilation, supported by air filtration and GUV disinfection, is not mentioned in a single word.

This lesson of the pandemic is buried deeply so that the WHO does not have to admit its misleading advice at the beginning of the pandemic that the virus was not airborne. 'Airborne transmission' of respiratory infections is still a banned term!

The WHO announcement is well-aligned with Australia’s ‘National COVID-19 health management plan for 2023’. It recognises the ongoing burden and risks of COVID-19, but necessarily integrates these into the wider context of ongoing health challenges requiring sustainable programs for disease prevention and control.

Both documents call for attention to equity goals through risk-based approaches and community-engaged development of evidence-informed action and policies. Most importantly, the WHO announcement highlights the importance of avoiding the ‘panic-neglect’ cycle. We must ensure that lessons learned from successes and gaps in the COVID-19 response are carried forward into investment in stronger systems for research, monitoring, preparedness and response to the next emerging challenge.

We are three years into the pandemic and globally there is increasing COVID-19 fatigue. As we move into a phase of living with COVID-19, we need to remember that like other respiratory viruses, such as RSV and influenza, the circulating variants of SARS-CoV-2 are also very infectious.

Globally the pandemic has provided the opportunity to enhance our surveillance system. We must continue to have effective surveillance systems in place to monitor emerging variants and infectiousness of not only the SARS-CoV-2 virus but other respiratory viruses which have the potential to cause health crises and strain our health system. It is equally important to advocate for the equitable distribution of vaccines and therapeutics against COVID-19.

Last night, the World Health Organization decided that COVID continues to be a public health emergency of international concern, but also that it is at a transition point. I think they are spot on this time. We are no longer in an epidemic situation, but neither have we reached endemicity. We are somewhere in between. COVID-19, unlike influenza, is not a seasonal virus, hence the recently announced US move towards an annual COVID-19 jab might be a bit premature. With influenza, we get a flu jab just before the start of the flu season, and that gives us protection for 4-5 months, basically covering the flu season. However, because COVID-19 is not (yet) seasonal, a single jab protecting for 4-5 months is clearly not sufficient until we get better vaccines.

The WHO have made seven recommendations to members states:

1. That member states maintain momentum for COVID-19 vaccination to achieve 100% coverage of high-priority groups.
   This is a sensible suggestion. Younger people who are at lower risk are becoming increasingly vaccine-hesitant. We must focus on our at-risk population and get them vaccinated;
2. Improve reporting of SARS-CoV-2 surveillance data to WHO.
   Australia is behind many other countries in terms of data. For example, we do not have a COVID-19 registry, we have no national wastewater monitoring system, or regular national serum prevalence surveys;
3. Increase uptake and ensure long-term availability of medical countermeasures.
   Australia has managed reasonably well in its access to vaccines and therapeutics. Some might argue that ATAGI is a bit too conservative, and slower than other countries to endorse new vaccines, but by and large, it does a very good job;
4. Maintain strong national response capacity and prepare for future events to avoid the occurrence of a panic-neglect cycle.
   Australia is the only OECD country without a Centre for Disease Control (CDC). Thankfully, this is about to change with planning well underway for our own CDC – perhaps an ACDC!
5. Continue working with communities and their leaders to address the infodemic and to effectively implement risk-based public health and social measures (PHSM). 
   Australia has been hopeless in their communication strategy (or lack of one). Governments have consistently ignored public health advice about PHSM.
6. Continue to adjust any remaining international travel-related measures, based on risk assessment, and to not require proof of vaccination against COVID-19 as a prerequisite for international travel.
   Hmmm! – China?
7. Continue to support research for improved vaccines that reduce transmission and have broad applicability, as well as research to understand the full spectrum, incidence and impact of post COVID-19 condition, and to develop relevant integrated care pathways.
   Our Medical Research Future Fund has been funding research into vaccine strategy and long COVID, but clearly much more needs to be done.

These are sensible recommendations from the WHO – let us hope that the Australian government takes notice of them.

OzSAGE supports the WHO in their statement that the pandemic is not over and remains a public health emergency. OzSAGE is concerned about the excess deaths related to COVID in Australia during 2022. COVID is now the third-, and on some days the second-highest cause of death in Australia. There is every indication that unless Australia changes its stance on managing COVID, this trend will continue into 2023.

It is clear more needs to be done to reduce the excess deaths from COVID. This includes higher levels of booster vaccinations, delivery of safe indoor air in public settings, the use of masks in poorly ventilated indoor areas, the return to free widely accessible testing and review of mitigations used in high-risk settings such as aged care facilities.

OzSAGE remains committed to providing independent consensus advice from their diverse expert group to assist in this pandemic."

The main message of the report is: 'The COVID-19 pandemic is NOT over'. As it has stated in the WHO report more than 170,000 patients have died due to COVID-19-related issues in the last 8 weeks.

All of those cases were related to different variants of Omicron.  Due to continuous virus evolution, keeping an accurate record on which sub-variant of COVID-19 is spreading in the world, provides critical information on management of the pandemic.

Due to health workforce shortages, surveillance and genetic sequencing have declined globally. It makes the situation more difficult to track known variants and detect new ones. This situation puts the global health authorities in the dark, due to the lack of information on the creation of new COVID-19 variants in populations.

Complications from influenza and respiratory syncytial virus (RSV) make the situation worse. Due to the genetic diversity and evolution capacity of COVID-19, the virus retains an ability to evolve into new variants with unpredictable characteristics. Those capabilities may increase the virulence (Delta variant experience in 2021-22) or increase the infectivity (Omicron variant experience in 2022).

The main goal for the current situation is achieving higher levels of population immunity, either through infection and/or vaccination. A conclusion of the WHO report is that the COVID-19 virus will remain a permanently established pathogen in humans and animals for the foreseeable future. One of the most effective suggestions for the current situation is to maintain momentum for COVID-19 vaccination to achieve 100% coverage of high-priority groups guided by the evolving SAGE recommendations on the use of booster doses.

We had 2,200 deaths in the first 22 months of the pandemic but we have had nearly 16,000 deaths in the last 13 months – it's hard to say the pandemic is really over. However, we haven’t seen a new variant of concern in over a year which is a good sign.

Vaccination remains most effective against severe disease. People can be vaccinated and still get mild disease, and while they might feel awful, vaccination is helping to keep them out of hospital.

The rapidly unfolding situation in China suggests that their Zero-COVID policy was not keeping the Omicron virus under control - i.e. Omicron was out of control before the zero policy was stopped. The large numbers of deaths we are seeing in China in such a short time period suggests the virus was there all along, causing trouble in October and November.

We may be increasingly confident that a new variant of concern isn't imminent, but not yet certain.

I agree with WHO that the pandemic remains a public health emergency. COVID remains a relatively rampant taker of Australian lives and this country has the power to regulate safe indoor air in our aged care, schools, hospitals, prisons, businesses and public places and should do so.

We have the practical means with ventilation and filtration. Governments also can improve vaccination uptake, masking and testing. We have a worker shortage, including in our critical industries, and to neglect ways to prevent COVID spreading tears at the fabric of our society whether through excess deaths, no healthcare availability or difficulties in educating the next generation.

The definition of a Public Health Emergency of International Concern (PHEIC) is that there is an extraordinary health event that can affect multiple countries by crossing international borders and requires a coordinated international response. COVID-19 would still meet this definition, particularly with regard to global accessibility to and distribution of vaccines, as well as the sharing of surveillance in a timely manner as new variants and subvariants emerge.

Symbolically, it is also a gesture to remind COVID-fatigued populations and governments that COVID-19 should not be forgotten. Also, the nature of a PHEIC is that the involved committee meets every three months to review the status, meaning that the PHEIC may be revoked in the next 3-9 months anyway. However, continuing to call COVID-19 a PHEIC doesn't mean that the situation is as serious as before. It is apparent that with hybrid immunity from a combination of vaccination and natural infection, the use of antivirals, and the ongoing presence of Omicron for >1 year, that the latest waves of COVID-19 aren't as severe as previously in many regions. 

The PHEIC has been maintained to remind us that though the pandemic is gradually heading towards a less serious endemic phase, COVID-19 is still serious and it will always be preferable not to get COVID-19 rather than to get it, and if we do get it, ensure that we have vaccinated ourselves (and taken antivirals if appropriate) to minimize the risk of severe disease. That preparation for endemicity will involve governments making sure that clinical pathways for COVID-19 have been integrated into existing healthcare pathways, ongoing surveillance of COVID-19 variants and subvariants continue, easy access to vaccines, optimization of infection control practices for COVID-19 in nursing homes and hospitals, and addressing misinformation as it arises

Well, the jaded response would be ‘well, obviously’, from the forward-facing, acute health care responder’s perspective. Emergency departments are full across the country, as a consequence of the downstream effects of the pandemic, both with increased demands, and a decreased capacity for flow, because of hospital bed occupancy.

The direct numbers of COVID-19 cases being measured are not a reliable indicator of community burden, not only because we’re just not measuring accurately, but because the burden being borne by the healthcare system is also that of the indirect effects of the pandemic, such as the reduced availability of ‘normal’ health services to those with chronic diseases. These patients become unstable, requiring more resources than they would have done, and that are deliverable outside of hospitals.

With the return to school this week we are likely to see surges in demand, demand from an already exhausted workforce. Similarly, the return to universities of students could spell trouble for real case numbers. Aged care facilities are doing poorly. Death rates, probably now the only granular data set being measured with rigorous accuracy, are nowhere near an acceptable level to any group of healthcare workers.

The economic recovery of any country is predicated on having a healthy workforce to service its needs. Placing the health and well-being of the workforce at the centre of any pandemic response ensures that can be achieved, and this has been demonstrated consistently. The corollary has only been shown to simultaneously reduce the economic, AND physical health of jurisdictions that persist in putting profits ahead of the well-being of patients.

The WHO released a statement on 30 Jan 2023, that the COVID-19 (coronavirus disease) pandemic continues to be PHEIC (Public Health Emergency of International Concern), however, the pandemic is at a transition and inflexion point.

Currently, the virus will continue to circulate in humans for the near future and there are descendant sub-lineages of variants circulating, especially the Omicron variant. Whilst the Omicron variant continues to be highly infectious, there appears to be a reduction in the severity of the disease.

WHO asked countries to continue with their COVID-19 response along with the management of other diseases, and to remain vigilant. The statement also acknowledged that pandemic fatigue had set in, there is a reduction in testing and reporting and there are global health workforce shortages.

There were seven recommendations including increasing vaccination and booster rates, especially among high-risk groups; improving surveillance; increasing access to anti-virals and therapeutics; continuing effective public health and community responses; monitoring international travel and supporting research to develop updated vaccines, provide evidence, and provide an understanding of the impact of COVID-19.