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The Covid-19 pandemic reached a major milestone this month when public health emergency declarations ended for both the U.S. government and the World Health Organization. emergency declarations for mpox also recently finished.
This does not mean that Covid-19 and mpox are no longer a concern, but it does mark the end of the availability of certain logistical capabilities to manage them.
Still, other critical health challenges were identified as health emergencies years before the start of the Covid-19 pandemic and continue to be so: the opioid crisis in the US and the global spread of the poliovirus.
Some public health concerns can be serious health threats without a formal emergency declaration, said Dr. Tom Frieden, former director of the US Centers for Disease Control and Prevention.
It largely comes down to the logistics of government operations.
“When there is an unusual situation that requires multiple parts of an agency or multiple parts of the government or multiple parts of society to come together and coordinate, collaborate and work efficiently, then an emergency declaration can be a useful tool,” he said. Freden, President. and CEO of Resolve to Save Lives, an organization focused on global epidemic prevention and cardiovascular health.
“Sometimes an emergency is declared to point out that it’s a big problem, to get people’s attention. Sometimes an emergency is declared to get things done because that’s the only way you can assert certain government capabilities.”
According to the WHO, a public health emergency of international concern is “an extraordinary event” that poses a risk to public health through the international spread of disease.
Creates an agreement between countries to comply with WHO recommendations for handling the emergency, which often requires a “coordinated international response.” Each country, in turn, declares its own public health emergency, declarations that carry legal weight. Countries use them to pool resources and waive the rules to alleviate a crisis.
In the US, the Secretary of the Department of Health and Human Services can declare a public health emergency for threatening diseases or conditions, including “significant outbreaks” of an infectious disease, bioterrorist attacks, or others.
This triggers the availability of a set of resources and actions for the federal government, such as additional funding and information and reporting requirements.
Emergency declarations typically last up to 90 days, after which a formal renewal is required as needed every three months.
The opioid crisis was determined to be a public health emergency in October 2017, during the Trump administration, fueled by rising rates of opioid-related deaths and opioid use disorder.
The statement has been renewed for more than five years, most recently in late March.
According to the CDC, the opioid epidemic began in 1999 with an increase in overdose deaths from prescription opioids. Deaths began to skyrocket as synthetic opioids, particularly fentanyl, began to take over in 2013.
In 2021, overdose deaths reached record levels in the US, with about three-quarters (more than 80,000 deaths) involving opioids.
Within the first year of the opioid emergency declaration, HHS used extended authorities conduct a survey on opioid use disorder treatment among providers and accelerate research on the topic.
Public health emergencies are also declared to help with recovery after natural disasters, most recently severe storms that hit Mississippi in March.
However, the Government Accountability Office considers both the federal management of the public health emergency system and efforts to combat drug abuse to be “high risk” areas that are vulnerable or in need of extensive reform.
In a recent reportThe federal watchdog group said it has found “persistent deficiencies in HHS’s leadership role in preparing for and responding to public health emergencies” and no demonstrated progress in actions by federal agencies to address drug misuse.
The WHO has considered poliovirus a public health emergency of international concern since 2014.
A committee formed to deal with the emergency reviewed the most recent data on cases and dissemination for this month and voted unanimously that the ongoing risks warranted an extension of the emergency declaration, which the director general formalized on Friday.
The committee was “encouraged by the reported progress” but says the risks remain high due to factors including weak vaccination rates that could have been affected by the Covid-19 pandemic.
The WHO identified seven counties with potential risk of international spread. And the United States is among a group of 37 countries with newly detected cases.
In July, a polio case identified in New York became the first in the US in nearly a decade. The identified case, along with several positive sewage tests in nearby communities, met the WHO criteria for considering the US a country with circulating poliovirus.
The experts warned that it could just be the “tip of the iceberg”, with hundreds of cases spreading quietly.
Childhood vaccination rates in the US dropped during the Covid-19 pandemic. A CDC report found that about 93% of kindergarten children enrolled in the 2021-22 school year received required immunizations, including measles, mumps, and rubella (MMR) vaccines; diphtheria, tetanus, and acellular pertussis (DTaP); and polio. Coverage fell for the second year in a row amid the pandemic, from around 94% the year before and below the federal goal of 95%.
While no longer under a formal emergency declaration, Covid-19 is still part of the “health threat landscape,” Frieden said.
But the efficiency and coordination that the formal declaration helps to facilitate should always be the goal.
“I think there are really important lessons from Covid, including the need to have a much more resilient public health system so that we can find problems quickly and implement effective solutions quickly,” Frieden said.
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