Exiting the pandemic

What’s next?


How will Omicron play out?

The World Health Organization (WHO) declared the end of the emergency phase of the Covid-19 pandemic on May 5, 2023 with much hope but also with caution. Even as the world rejoiced with this announcement, the WHO warned that Covid-19 was still very much around, and that the pandemic itself was not over.

Many countries had moved on from the pandemic to an endemic phase prior to the announcement. Many of us in the medical field fully expected WHO to make the declaration in January 2023, but the downgrade was delayed due to uncertainties over the emergence of new Omicron sublineages as well as gaps in vaccination and the poor uptake of boosters. Over the last four months, it has become apparent that even these new Omicron sublineages no longer presented much of a threat to healthcare systems, thanks to widespread vaccination. The SAGE-WHO panel, which makes vaccine recommendations, recently released advice that recommended second boosters only for the most vulnerable populations and did not even comment on the need for bivalent vaccines. It was clear that vaccines had turned the tide, and we were not going back.
So, what’s next? Should we now go back to our prepandemic normal? The WHO specifically warns against this mindset. The full WHO statement is on its website (https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic), and I will attempt to synthesize and put into our local context its recommendations.

Aside from stating that Covid-19 is still very much around, WHO urges that countries maintain the infrastructure and other national capacity gains made in response to the Covid-19 pandemic in preparation for future events. For instance, our genomic surveillance capability as well as our ability to roll out vaccines in different areas of the Philippines should be preserved and incorporated into our pandemic preparedness plans. The lessons learned by our national and local governments in coordinating emergency responses should be codified into a pandemic playbook, which can be quickly implemented in the event of another global outbreak.

WHO also recommends that Covid-19 vaccination be incorporated into vaccination programs, especially for those in high-risk groups. In the Philippines, this will entail that the vaccine manufacturers work toward receiving a certificate of product registration (CPR) for their Covid-19 vaccines so that health care providers can give primary series shots and any needed boosters in their clinics. While the emergency use authority (EUA) for the current vaccines will remain in effect for one year from the lifting of the state of emergency, this is not an ideal situation since new updated vaccines cannot be given new EUAs. CPRs will enable private entities to procure Covid-19 vaccines on their own. The government is expected to still procure a sufficient stock of vaccines for high risk and indigent populations, who may not be able to afford them, as long as these are deemed cost-effective by the Health Technology Assessment Council (HTAC).

The WHO recommends that surveillance of SARS-CoV-2 along with other respiratory pathogens such as influenza should be brought together comprehensively to have advance warning of any potential outbreaks. Since many influenza-like illness networks already have preexisting sentinel sites, additional testing for other respiratory illnesses can be added to expand the detection of epidemic threats.

The WHO also recognized the severe damage that fake news caused during the pandemic, and it recommends that communities and their leaders work together to address this. The infodemic continues to wreak havoc on vaccination programs and undermine trust in science. Agents of misinformation need to be identified and exposed. Messaging needs to be balanced to be accurate and palatable without downplaying or sensationalizing the actual level of risk. Local contexts need to be taken into consideration to be sensitive to cultural norms and achieve the correct level of preparedness while properly managing limited resources.
WHO encourages countries to lift Covid-19 international travel related health measures as the impact of Covid-19 across borders is unlikely to result in severe outbreaks. The WHO still recommends proper risk assessment, but in general most countries have vaccinated their populations and are able to cope with incoming Covid-19 variants of concern. Proof of vaccination against Covid-19 should no longer be required as a prerequisite for international travel since there is already widespread immunity to severe infection.

Finally, WHO recommends that countries continue to support research to improve vaccines, especially those that reduce transmission and have broad applicability. They also encourage research that looks into understanding the full spectrum, incidence, and impact of long Covid and the evolution of SARS-COV-2 in immunocompromised populations. Integrated care pathways should be developed for these patients since the burden of illness will be higher for these at-risk and vulnerable individuals.

The WHO statement provides a best-practices pathway not just for exiting the pandemic but for preparing for future pandemics. As a physician and a scientist, I was at ground zero in experiencing the acute logistical problems at the start of the pandemic. Many healthcare workers did not have proper masks and PPE, and we scrambled to increase test capacity even as the virus spread. Infrastructure for reporting case numbers and deaths were hastily put together in fits and starts, and policies for quarantine, isolation, and contact tracing were put together on the fly. To be fair, the entire world struggled to understand and control SARS-CoV-2, with many resource-rich countries doing much worse than us.

Thanks to our healthcare workers, the government and the private sector helping each other, our final case and death tally per capita are among the best in the world. Hundreds of thousands of Filipino lives were saved. We cannot count on luck and chance, however, to see us through the next time a pandemic hits. The lessons learned, even as we relax restrictions, need to be institutionalized so that the next pandemic will have a much lesser impact. If there is a silver lining to all this, it is the realization that when policy makers and politicians listen to the scientists and doctors, countless lives can be saved. With hope, they will keep on listening.