W.H.O. Ends Covid World Health Emergency Designation

The World Health Organization announced on Friday that it was ending the emergency it declared for Covid-19 more than three years ago, a milestone in the fitful emergence from a pandemic that has killed millions of people around the world and upended daily life in previously unimaginable ways.

“It is with great hope that I declare Covid-19 over as a global health emergency,” said the W.H.O. director general, Tedros Adhanom Ghebreyesus.

But W.H.O. officials warned that the decision to lift the emergency does not signal an end to the pandemic, and cautioned countries not take this as reason to dismantle Covid response systems. Dr. Maria Van Kerkhove, the W.H.O. technical lead on Covid, said the organization wanted to be as clear as possible knowing that people would wonder how to think about the pandemic going forward.

“The emergency phase is over, but Covid is not,” she said.

Indeed, in practical terms, the decision to end the emergency changes little. Many countries have already ended their own states of emergency for Covid, and have moved away from almost all public health restrictions implemented to control the virus. The United States will lift its Covid emergency on May 11. But the lifting of the W.H.O. designation — officially called a “public health emergency of international concern” — is a significant moment in the evolving human relationship with the novel coronavirus.

Dr. K. Srinath Reddy, who led India’s Public Health Foundation through the pandemic, said the decision to lift the emergency was appropriate, because of the high levels globally of immunity to Covid, induced by vaccination or infection, or both.

“It no longer possesses the same level of danger,” he said, adding that Covid “has achieved a level of equilibrium, a certain type of coexistence with the human host.”

Dr. Reddy said the end of the emergency status should also be appreciated as a moment of human achievement and a “celebration of science.”

“It’s important to recognize that what made the virus change its character is not only evolutionary biology,” he said, “but also the fact that we have induced it to actually become less virulent, by vaccination, by masks, by a number of public health measures.”

Globally, there have been 765,222,932 confirmed cases of Covid, including 6,921,614 deaths, reported to the W.H.O. as of May 3. But these figures are a vast undercount of the pandemic’s true toll. “We know the true toll is several times higher, at least 20 million,” Dr. Tedros said.

A year ago the W.H.O. said that 15 million more people had died in the first two years of the pandemic than would have in normal times, a figure that laid bare how vastly countries had undercounted victims. In Egypt, excess deaths were roughly 12 times as great as the official Covid toll; in Pakistan, the figure was eight times as high. Developing nations bore the brunt of the devastation, with nearly eight million more people than expected dying in lower-middle-income nations by the end of 2021.

“Covid-19 has been so much more than a health crisis: it has caused severe social upheaval,” said Dr. Tedros, describing crippled economies, closed borders, shuttered schools and millions of people suffering in isolation.

“Covid-19 exposed and exacerbated political fault-lines within and between nations,” he said. “It has eroded trust between people, governments and institutions fueled by a torrent of myths and misinformation. It has laid bare the searing inequalities of our world, with the poorest and most vulnerable communities the hardest hit and the last to receive access to vaccines and other tools.”

The W.H.O. leaders who addressed the media about the ending of the emergency described the moment as an emotional one. “It didn’t have to be this way,” Dr. Van Kerkhove said. “We can’t forget the images of the hospital ICUs filled to capacity, the images of medical gloves filled with warm water holding the hands of our loved ones who died, with health care workers who ensured that they didn’t die alone. We can’t forget the fire pyres or the mass graves that were dug.”

Covid, she noted, continues to spread: The W.H.O. recorded 2.8 million new cases globally, and more than 17,000 deaths, from April 3 to 30, the most recent numbers available. As many countries have reduced their testing for Covid, these numbers also probably represent a significant undercount.

The W.H.O.’s emergency declaration was a crucial piece of guidance when it was made on Jan. 30, 2020, when just 213 people were known to have died of the virus. It signaled to the world that this new virus posed a threat outside of China, where it emerged, and gave countries critical buttressing to impose potentially unpopular or disruptive public health measures.

The virus that jumped into humans in late 2019 proved to be an unpredictable adversary, mutating swiftly and significantly in ways that allowed it to resurge and devastate countries just as they thought the worst was past.

A brutal wave of the Delta variant ravaged India just weeks after Prime Minister Narendra Modi bragged about how well the country had done in its Covid response. The Omicron variant, while less virulent, spread with a deceptive ease that made it the fourth-leading cause of death in the United States in 2022, and a major killer in many other countries.

The first large-scale vaccinations began on Dec. 8, 2020, less than a year after the first case of the disease was reported to the W.H.O., an extraordinary triumph of science. But the collaborative process of vaccine development was followed by a grim period of hoarding and nationalism; a full year later, when people in industrialized countries were receiving second and third doses of the vaccine, just five percent of people in sub-Saharan Africa had been vaccinated.

Dr. Githinji Gitahi, executive director of Amref Health Africa, said it was time to lift the emergency. “The danger of keeping it forever is diluting the tool — you need it to retain its force,” he said.

The declaration helped to mobilize resources for Africa, he said, but did nothing to counter the bleak experience of what he called “vaccine injustice.” Amref continues to work on supporting vaccination in 35 African countries; continentwide, coverage now stands at 52 percent.

The pandemic also has a positive legacy, Dr. Gitahi said, because it spurred the highest level of cooperation ever seen among African countries, including the creation of an African Union task force to coordinate procurement of vaccines. The Covid response has led to increased capacity and investment in many African countries in areas such as genomic sequencing and disease surveillance.

The W.H.O. decision was not welcomed by all health experts. Dr. Margareth Dalcolmo, a respiratory physician and member of Brazil’s National Academy of Medicine who was one of that country’s most prominent experts guiding the public through Covid, said it was too soon to lift the emergency, given that there are still urgent tasks such as research into Covid variants and development of multivalent vaccines. The designation of global public health emergency also creates leverage for lower-income nations to access treatments and support, she said.

On May 3, the W.H.O. issued an updated Covid management plan, which it said was intended to guide countries on how to manage Covid over the next two years as they transition from emergency response to long-term Covid prevention and control.

Opening the Geneva meeting where W.H.O. experts decided to end the emergency, Dr. Tedros told the committee that for each of the past 10 weeks, the number of weekly reported Covid deaths had been the lowest since March 2020. As a consequence, life has returned to normal in most countries and health systems are rebuilding, he said.

“At the same time, some critical uncertainties about the evolution of the virus persist, which make it difficult to predict future transmission dynamics or seasonality,” he said. “Surveillance and genetic sequencing have declined significantly around the world, making it more difficult to track known variants and detect new ones.”

And access to lifesaving Covid treatments continues to be sharply unequal globally, he said.

Dr. Dalcolmo said the lifting of the global emergency should be viewed not as a milestone, but as a warning. “Take this as an alert, a time to start being prepared for the next pandemic,” she said, “because we know respiratory viruses are going to increase.”