COVID-19 is first and foremost an international health challenge. The World Health Organization (“WHO”) spearheads international efforts at developing and communicating information on the coronavirus, coordinating efforts at addressing the health response and working with other organizations to help countries around the world obtain needed medical supplies and to facilitate best practices in addressing the pandemic. While the United States has given notice of its withdrawal from the WHO (which takes effect six months after the notice), the WHO is a critical organization for a coordinated response to health pandemics such as COVID-19. For example, the WHO put out on February 3, 2020, a publication entitled, “2019 Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan” and followed that up last month with a progress report covering 1 February to 30 June 2020. See https://www.who.int/docs/default-source/coronaviruse/covid-strategy-update-14april2020.pdf?sfvrsn=29da3ba0_19; https://www.who.int/publications/m/item/who-covid-19-preparedness-and-response-progress-report—1-february-to-30-june-2020. These types of publications provide important information to nations around the world as well as documenting progress being made in controlling the spread of the pandemic.

This post looks at several recent activities of the WHO.

July 31, 2020 4th Meeting of the Emergency Committee regarding the outbreak of coronavirus disease (COVID-19)

On July 31, a meeting of health experts from around the world was convened by the WHO’s Director-General under the Inernational Health Regulations (IHR)(2005). It was the fourth meeting of the Emergency Committee regarding the outbreak of coronavirus disease (COVID-19). A statement was released from the meeting on August 1. https://www.who.int/news-room/detail/01-08-2020-statement-on-the-fourth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-coronavirus-disease-(covid-19).

Much of the work of the Emergency Committee is confidential but the statement released includes a summary of issues reviewed and advice provided to the WHO and to States Parties. As reviewed in yesterday’s post, the number of new COVID-19 cases continues to increase around the world. While most of the growth is in developing and least-developed contries, the United States continues to experience huge numbers of new cases, increasing hospitalizations and increasing deaths. Many other developed countries are seeing some resurgence of cases as their economies reopen. See August 2, 2020,  Review of the COVID-19 pandemic – continued growth in cases and deaths, resurgence in some countries where COVID-19 had receded, https://currentthoughtsontrade.com/2020/08/02/review-of-the-covid-19-pandemic-continued-overall-growth-in-cases-and-deaths-resurgence-in-some-countries-where-covid-19-had-receded/.

While many developing and least-developed countries have had relatively small numbers of cases, that is not true for all such countries. Moreover, the sharp contraction in GDP and trade volumes in developed countries and developing countries with large numbers of cases has meant that the economic damage for many of the poorest countries is mounting and is debilitating. The World Bank and IMF are both actively engaged in providing financial assistance to many developing and developed countries. Still the World Bank’s June 2020 Global Economic Prospects estimates that COVID-19 will result in 71-100 million people being pushed into extreme poverty. See https://www.worldbank.org/en/topic/poverty/brief/projected-poverty-impacts-of-COVID-19; World Bank, Global Economic Prospects, June 2020, https://openknowledge.worldbank.org/handle/10986/33748.

Thus, with the continued growth in global cases, the increased concentration in developing and least-developed countries and the huge economic effects occurring as countries try to reduce the spread of COVID-19, it is not surprising that the Emergency Committee “unanimously agreed that the pandemic still constitutes a public health emergency of international concern.” The WHO’s Director-General included a declaration to that effect in the statement released on August 1.

Below is the advice the Committee provided to the WHO Secretariat and the temporary recommendations to State Parties (all material to the next header is from the statement):

Advice to the WHO Secretariat

1. Continue to distill and rapidly communicate lessons learned and best practices from the COVID-19 pandemic and national
   intra-action reviews.
2. Continue to coordinate and mobilize global and regional multi- lateral organizations, partners and networks for robust political
   commitment and resourcing of COVID-19 pandemic preparedness and response, including for development of vaccines and
   therapeutics.
3. Provide nuanced, pragmatic guidance on criteria for appropriate COVID-19 response activities to reduce the risk of response fatigue in the context of socio-economic pressures.
4. Continue to support State Parties and partners in conducting active and community-based COVID-19 surveillance, through technical and operational resources, such as guidance, tools, and trainings on case definitions and identification, contact tracing, and death certifications; encourage State Parties to continue reporting relevant data to WHO through platforms such as the Global Influenza Surveillance and Response System.
5. Accelerate research into remaining SARS-CoV-2 critical unknowns, such as the animal source and potential animal reservoirs, and improve understanding of the epidemiology and severity of COVID-19 (including its long-term health effects; viral dynamics such as modes of transmission, shedding, potential mutations; immunity and correlates of protection; co-infection; as well as risk factors and vulnerabilities) and the effectiveness of public health measures.
6. Continue to work with partners to counter mis/disinformation and infodemics by developing and disseminating clear, tailored
   messaging on the COVID-19 pandemic and its effects; encourage and support individuals and communities to follow recommended public health and social measures.
7. Support diagnostics, safe and effective therapeutics and vaccines’ rapid and transparent development (including in developing countries) and equitable access through the Access to COVID-19 Tools (ACT) Accelerator; support all countries to implement the necessary clinical trials and to prepare for the rollout of therapeutics and vaccines.
8. Work with partners to revise WHO’s travel health guidance to reinforce evidence-informed measures consistent with the provisions of the IHR (2005) to avoid unnecessary interference with international travel; proactively and regularly share information on travel measures to support State Parties’ decision-making for resuming international travel.
9. Support State Parties, particularly vulnerable countries, in strengthening their essential health services and accompanying
   supply chains as well as preparing for and responding to concurrent outbreaks, such as seasonal influenza.

Temporary recommendations to State Parties

1. Share best practices, including from intra-action reviews, with WHO; apply lessons learned from countries that are successfully
   re-opening their societies (including businesses, schools, and other services) and mitigating resurgence of COVID-19.
2. Support multilateral regional and global organizations and encourage global solidarity in COVID-19 response.
3. Enhance and sustain political commitment and leadership for national strategies and localized response activities driven by science, data, and experience; engage all sectors in addressing the impacts of the pandemic.
4. Continue to enhance capacity for public health surveillance, testing, and contact tracing.
5. Share timely information and data with WHO on COVID-19 epidemiology and severity, response measures, and on concurrent disease outbreaks through platforms such as the Global Influenza Surveillance and Response System.
6. Strengthen community engagement, empower individuals, and build trust by addressing mis/disinformation and providing clear guidance, rationales, and resources for public health and social measures to be accepted and implemented.
7. Engage in the Access to COVID-19 Tools (ACT) Accelerator, participate in relevant trials, and prepare for safe and effective therapeutic and vaccine introduction.
8. Implement, regularly update, and share information with WHO on appropriate and proportionate travel measures and advice, based on risk assessments; implement necessary capacities, including at points of entry, to mitigate the potential risks of international transmission of COVID-19 and to facilitate international contact tracing.
9. Maintain essential health services with sufficient funding, supplies, and human resources; prepare health systems to cope with seasonal influenza, other concurrent disease outbreaks, and natural disasters.

Travel and Tourism

In prior posts, I have reviewed the devastating economic consequences of the pandemic on the travel and tourism sector of global economies as countries have restricted entry of people from many countries to reduce the likelihood of travelers having and spreading COVID-19. See April 30, 2020, The collapse of tourism during the COVID-19 pandemic, https://currentthoughtsontrade.com/2020/04/30/the-collapse-of-tourism-during-the-covid-19-pandemic/; May 3, 2020, Update on the collapse of travel and tourism in response to COVID-19, https://currentthoughtsontrade.com/2020/05/03/update-on-the-collapse-of-travel-and-tourism-in-response-to-covid-19/.

The airline industries around the world are in serious trouble, as are restaurants, bars, hotels, sports and entertainment venues and more. The reduced level of air traffic has greatly reduced air cargo availability which has increased costs for many products. At the same time, countries have struggled to find ways to expedite movement of medical goods and permit the travel of essential personnel (e.g., health professionals, transportation employees, etc.). There are not uniform standards being applied by countries on access of international travelers which means confusion and less movement than would happen under agreed rules.

On July 30, the WTO released a document, entitled “Public health considerations while resuming international travel”. The link follows and the document is embedded below. https://www.who.int/news-room/articles-detail/public-health-considerations-while-resuming-international-travel.

Public-health-considerations-while-resuming-international-travel

The paper advises each country to conduct a risk-benefit analysis and decide on the national priorities of permitting the return/expansion of international travel.

“WHO recommends that priority should be given to essential travel for emergencies, humanitarian actions (including emergency medical flights and medical evacuation), travel of essential personnel (including emergency responders and providers of public health technical support, critical personnel in transport sector such as seafarers[5] and diplomatic officers), and repatriation. Cargo transport should also be prioritized for essential medical, food and energy supplies. Sick travellers and persons at risk including elderly travellers and people with chronic diseases or underlying health conditions, should delay or avoid travelling internationally to and from areas with community transmission.

“There is no ‘zero risk’ when considering the potential importation or exportation of cases in the context of international travel. Therefore, thorough and continuous risk assessment and management will help identify, reduce and mitigate those risks, while balancing the socio-economic consequences of travel measures (or temporary restrictions) against potential adverse public health consequences.

“The decision process should include an analysis of the situation, taking into account the local context in countries of departure and destination. The following factors should be considered: local epidemiology and transmission patterns, the national public health and social measures for controlling the outbreaks in both departure and in destination countries; public health and health service capacity at national and subnational levels to manage suspect and confirmed cases among travellers, including at points of entry (ports, airports, ground crossings) to mitigate and manage the risk of importation or exportation of the disease; and the evolving knowledge about COVID-19 transmission and its clinical features.”

All countries need to find ways to handle the travel of essential personnel and those involved with emergencies. However, as the note makes clear, while expanding international travel is important for countries, there are a host of considerations that will make movement of non-essential travel dependent on a range of considerations, including the extent to which the pandemic is under control in either the country from which passengers are travelling or in the country of entry. The EU’s list of countries from which non-essential travelers will be permitted into the EU is an example of the approach suggested by the WHO focusing on the extent of the spread in the country from which travelers would leave to arrive in the EU.

What the WHO note makes clear is that the fastest route to reopening of international travel safely is for greater cooperation among countries to both control the spread of COVID-19, for greater transparency in how governments are addressing emerging situations, and for greater attention to the level of health care preparedness to handle surges including testing, tracing and any needed quarantine capabilities.

Considering how quickly situations can change in a given country, an additional challenge for countries reopening international travel will be the flexibility and responsiveness of the country to changing health conditions in trading partners (and in its own country) over time.

Conclusion

The challenges of individual nations in addressing the COVID-19 pandemic should be made more manageable through cooperation with other nations and the work of multilateral organizations including the World Health Organization. Many countries have worked cooperatively to share information, including on research and best practices. The WHO provides a great deal of support to countries and serves as a gathering point for information to improve transparency in the health care responses around the world.

WTO Members need to address trade restrictions that have arisen as countries attempt to slow the spread of the COVID-19 pandemic. Reopening trade and keeping it open are critical to the ability of countries to minimize the economic fallout that has occurred in the first half of 2020 and will continue at least in part in the third quarter and likely beyond. Yet, the ability to keep markets open and increase international travel is complicated by the myriad differences between nations on factors like the level of COVID-19 infection, the health care infrastructure and ability of that infrastructure to handle surges where they occur. The WHO plays a critical role in helping nations understand the tools available to address the pandemic and the considerations that need to be taken into account when reopening markets, including international travel.