By Kirby Sokolow
From PHN Issue 54, Fall 2023
On May 5, 2023, the World Health Organization (WHO) announced that the COVID-19 pandemic “no longer constitutes a public health emergency of international concern (PHEIC).” Days later, the U.S.’s federal public health emergency (PHE) also ended.
These announcements left the world wondering: What does it mean to end a public health emergency? Do the two declarations mean the same thing? Is COVID finally “over”?
Unfortunately, neither announcement means that COVID-19 infections and their long-term effects are behind us. Upon announcing the end of the emergency, the WHO director-general also told audiences that, only the week before, “COVID-19 claimed a life every three minutes.” He also acknowledged the thousands of people still fighting the virus in intensive care units and millions with Long COVID. “The worst thing any country could do now,” he said, is “dismantle the systems it has built, or to send the message to its people that COVID-19 is nothing to worry about.”
While the pandemic isn’t over, the end of the PHEIC and the PHE signals a new phase in our relationship with COVID-19. This article breaks down both emergency declarations and what life without them looks like.
The WHO PHEIC
The WHO declared COVID-19 a public health emergency of international concern on Jan. 30, 2020. Although people in 18 countries had contracted COVID-19, this declaration was different from WHO leaders’ later, March 2020, announcement that we were in a pandemic. They made that call only when COVID was spreading so quickly and widely that they believed “the whole world’s population [would] likely be exposed.”
The PHEIC declaration was like a fire alarm: It alerted WHO member states about a new, dangerous, and quickly spreading disaster and called them to respond rapidly. Here, the “fire” was the “serious, sudden, unusual or unexpected” public health risk of COVID-19. A collaborative, global effort would be necessary to contain the international threat.
Like a fire alarm, the PHEIC wasn’t supposed to last forever—only until the necessary teams and tools were assembled, on the scene with a plan, and making progress.
Several factors contributed to the decision to remove the 10 “emergency” designation: COVID is no longer a new or unexpected threat; the global community has developed and implemented methods for slowing COVID’s spread and preventing severe disease; and weekly death rates are declining.
The end of the PHEIC means a shift from an intense, rapid response to COVID-19 to a more sustained, future-oriented approach. WHO leaders recommend that the systems developed during the PHEIC be directed toward the long-term management of COVID-19 and planning for and preventing future pandemics.
But not everything has changed. COVID-19 is still a threat, and the WHO will continue to promote widespread COVID-19 vaccination, including tackling the ongoing problem of inequality in vaccine distribution. It also continues to support research into improved vaccines, Long COVID, and COVID infections in people with compromised immune systems; strive to make public health communication stronger and more inclusive; and recommend ending international travel requirements.
The U.S. Federal Public Health Emergency (PHE)
One day after the WHO, then-President Trump and the Department of Health and Human Services also declared COVID-19 a public health emergency. The PHE enabled the U.S. to respond quickly to the health crisis by allowing the federal government more flexibility—including financial flexibility—in its approach.
Among other things, the declaration allowed all Americans, regardless of health insurance, to receive free COVID-19 tests, vaccines, and antiviral treatments. It also provided emergency funding to hospitals, allowed Medicaid to automatically re-enroll people so they wouldn’t become uninsured, and granted the Centers for Disease Control (CDC) access to rapid-response funding.
The expiration of the PHE means many of the tools the federal government used to track, prevent, and treat COVID infections have come to an end—or their cost now falls on insurance companies and individuals. Federal funding that kept COVID testing, antiviral treatments, and vaccines free is mostly gone. Vaccines will stay free for most folks for the time being, through Medicaid, Medicare, and private insurance. President Biden has also set aside $1.1 billion for vaccines for people without insurance. And Medicaid will cover COVID antiviral treatments and tests through September 2024, but because automatic reenrollment in Medicaid has ended, millions of people may lose their insurance and access to these tools by the end of 2023.
COVID data reporting has also changed. Labs aren’t required to report COVID-19 test results to the CDC anymore, so the agency cannot count and track cases as accurately as before. The CDC still has access to reliable data for COVID-19–related hospitalizations, ER visits, and deaths, which it collects and publishes now on a weekly basis, rather than daily.
Meanwhile, hospitals are no longer getting emergency funding at a time when many are still facing staffing shortages and budget shortfalls.
Other tools and practices do remain. For example, the FDA can still approve new COVID-19 tests, vaccines, and treatments for emergency use.
With all of these changes, people at a higher risk for COVID infections and complications are facing a world with fewer protections and greater isolation. Death and hospitalization rates from COVID might be trending downward, but they still aren’t low: At least 7,495 people in the U.S. died from COVID-19 in the 3 months leading up to July 15, 2023. Between widespread misunderstanding about what the end of the PHE means, the loss of free at-home testing, unreliable case counts, and hospitals dropping mask requirements, people most vulnerable to COVID-19 are finding it difficult to keep themselves safe. People with Long COVID also fear that, as data tracking slows down, new Long COVID cases will go unrecognized and research will be delayed or abandoned.
The rapid response to COVID-19 has ended, but the virus remains. And while tracking COVID cases in the U.S. is more difficult than it used to be, experts continue to emphasize the importance of vaccination and research into new prevention and treatment methods.
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