The World Health Organisation has declared China’s new coronavirus a global health emergency, citing the growing threat posed to countries with weak health systems.
“Our greatest concern is the potential for the virus to spread to countries [that] are ill-prepared to deal with it,” Tedros Adhanom Ghebreyesus, the WHO’s director-general, said in announcing the decision following an emergency meeting in Geneva on Thursday.
The coronavirus has spread rapidly since first being reported in the city of Wuhan, in China’s Hubei province, on 31 December. Confirmed infections reached the 20,000 mark by 4 February – the vast majority in China, with cases also reported in at least two dozen other countries and jurisdictions.*
Declaring a global health emergency – officially called a “public health emergency of international concern”, or PHEIC – can be symbolic as much as practical: it helps focus global attention and resources while emphasising WHO recommendations on how to respond.
The declaration accompanied a slew of recommendations for China, the WHO itself, and health authorities and policymakers around the world. The advice includes: reminders to share information on the evolving outbreak and prepare for its continued spread across borders; warnings against promoting “stigma and discrimination”; and pleas to help lower-income countries respond.
“We don’t know what sort of damage this virus could do if it were to spread in a country with a weaker health system,” Tedros said. “We must act now to help countries prepare for that possibility.”
What is a PHEIC?
Under international health regulations, a PHEIC can be considered during “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”.
Such decisions are rare – there have only been five other declarations in the last decade: the ongoing Ebola response in the Democratic Republic of Congo, declared last year; the spread of the Zika virus in 2016; declarations in 2014 for the re-emergence of polio and the West Africa Ebola outbreak; and the 2009 swine flu pandemic.
These declarations are meant to balance public health risks and “avoid unnecessary interference with international traffic and trade”, according to the WHO.
This has led to claims the process can be politicised: the WHO’s emergency committee met three times before finally declaring Congo’s Ebola outbreak a PHEIC last July.
The medical journal The Lancet called early decisions not to declare a PHEIC for Ebola “a mistake” that appeared to be “more political than technical”. (WHO advisors disagreed, saying a declaration added “no clear benefit” to the response at the time).
Similar debates hung over this week’s PHEIC announcement for the new coronavirus. The WHO panel initially chose not to declare a global health emergency after two days of deadlocked meetings last week.
The committee itself is calling for a more nuanced system that allows for “an intermediate level of alert between the binary possibilities of PHEIC or no PHEIC”.
Naming the disease
As the coronavirus evolves, so too does the question of what to call it.
The WHO is proposing a name that’s not particularly concise: “2019-nCoV acute respiratory disease”.
The process of naming a disease can be fraught. In the past, new diseases have often been named after animals, places, professions, and people – think “legionnaires’ disease”, “swine flu”, or “Rift Valley fever” (even Ebola takes its name from the Ebola River, near the sight of an early outbreak).
But this can trigger unexpected consequences: “We’ve seen certain disease names provoke a backlash against members of particular religious or ethnic communities, create unjustified barriers to travel, commerce and trade, and trigger needless slaughtering of food animals,” Keiji Fukuda, a former WHO official, said when the organisation released a “best practices” guide for naming diseases in 2015.
The guidelines recommend using terms describing symptoms, seasons, levels of severity, or dates when a disease is first reported. Some absolute red lines: no place names, no animals, no cultural group, and no “terms that incite undue fear”.
While people affected by the current coronavirus, or “2019-nCoV acute respiratory disease”, may benefit from a generic name, those WHO guidelines were too late for another recent disease.
Middle East Respiratory Syndrome – a cousin of the current coronavirus – was first identified in Saudi Arabia in 2012, and for a time was also simply called “a novel coronavirus” before it was officially named in 2013.
Now, MERS has a prominent place in the WHO’s naming guidelines: it’s the first entry under “examples to be avoided”.
* Figures updated on 4 February 2020.