public health emergency end date

public health emergency end date

The Importance of Defining the End Date of a Public Health Emergency

1. Introduction

Recognizing the problem with defining what has occurred in a public health emergency and the resulting confusion regarding the required actions for such events, there is a need to establish a clear starting point and ending point for a public health emergency. Defining the start and end dates involves placing the entire incident within the chronology of events, in order to clarify the events that led to the declaration and conclusion of a public health emergency, and to differentiate between time periods to understand the specific measures or actions taken and the consequences of those events. This process of dating the incident will help untangle the events and identify the specific events that led to the decision to implement a certain measure or policy, and determine if that measure or policy was carried out and its effectiveness.

Public health emergencies are scenarios that pose a risk to the health of a populace and call for the execution of special measures to stop infectious diseases from spreading, ensure a safe food and water supply, reduce the exposure to environmental and occupational hazards, or prevent injury and disability. The measures used in these situations are carried out in response to specific events or a series of events that overwhelm health resources in a community, and the enforcement of local, state, or federal health codes or laws. Often, the lines between the time frames of events, the actions taken, and the consequences of those actions become blurred. This can cause confusion regarding when an event started and stopped, what events led to a health emergency, and what constitutes a violation of the law. The ability to distinguish between the causes and effects of a public health emergency can be a challenge, as different time frames can lead to confusion in the implementation of policies during times of events.

2. The Need for a Defined End Date

A definitive end to an emergency signifies a time at which normalcy will be restored. Pavignani and Colombo said of humanitarian emergencies: “The most able and daring surgeon flounders in a mass of malformations and delicate anatomies if he lacks a mental image of the complete, fully-formed human body.” Unless a mental image exists of a post-emergency world, efforts during the emergency will lack direction and their impact will be difficult to gauge. A predefined endpoint facilitates planning and can serve as a trigger for the transition or withdrawal of certain resources and interventions. This will prevent resources being squandered on sustained interventions after the emergency is over and reduce the likelihood of dependence on external aid. Fassin highlights the problem of aid dependence in many postcolonial African countries where emergencies are an expected, regular, ordinary, and accepted state. Finally, a defined end date allows an evaluation of emergency response by providing a point at which to compare the actual duration of the emergency with the predicted duration which can lead to learning and improved responses in future emergencies.

3. Implications of an Undefined End Date

An emergency is declared to be over when the affected area and its population have recovered sufficiently to resume normal life, be that a new normal, and has the capacity to respond to any further incidents. During the 2009 pandemic, some experts claimed it was not yet time to declare the pandemic over, although outpatient visits for influenza-like illness had returned to baseline in the United States early in the pandemic wave. By early August 2010, two months after the WHO Director-General announced the start of the post-pandemic period, consultations with the Emergency Committee on when a decision should be made on this issue concluded that it was time to admit that the pandemic was ending phase. Coming to an agreement to declare the end of the Public Health Emergency of International Concern is hit-or-miss and certainly not the priority during the throes of the emergency. Often with the CEPR of the emergency, it will seem that its status really no longer reflects the reality of the international situation and decisions to change the phases will lag behind changes in the global situation. The types of evidence which should influence a decision to de-escalate the PEPR are outlined in the decision instrument for the Assessment and Declaration of the End of an Alert or PHEIC. This lack of defined ending means that some affected countries have been left feeling that they require aid and guidance until the situation seems to improve in the wealthier countries. A recent example of this is the 2014 Ebola epidemic where although the cases dropped dramatically, the Democratic Republic of Congo had stated that they assumed the PHEIC was still in effect.

4. Benefits of Establishing an End Date

By defining the problem as not meeting the target rather than failure, more recent efforts can still be seen with its full-scale increase behind the 2003 initiation of the Global Polio Eradication Initiative in which cases have been reduced by a factor of ten and resources continue to be poured into the cause. Considerably more ambitious, yet again a clear target was set in the end of the spread of HIV/AIDS with the formulation of United Nations resolution 1308 in 2000 with aims to reduce global HIV spread and its devastating impact on individuals, families, communities, and nations through comprehensive, evidence-based, and realistic strategies and resources. Although progress has been questionable, defining this target has allowed causal efforts to be pooled under global governance and has now led to the formation of UNAIDS and many concurrent partnerships and initiatives.

An end date can be decided in multiple ways. It may be a specific date, the depletion of a certain amount of resources or a certain achievement about which there is global consensus i.e. the eradication of smallpox. A clear example of where a specific end date led to reductions in effort before the actual end of a problem is the situation surrounding the eradication of polio. In 1988, the World Health Assembly set a global target to eradicate polio by the year 2000. This was a clear and measurable goal about which effort could be aimed and when resources could start being reduced and reallocated into other areas. We know its impact because there was a great reduction in polio cases across the next decade, but at the turn of the century, the initiative was still a long way from its goal.

The benefits of establishing an end date for a public health emergency have largely been ignored in the literature. We are so aggressively fighting to prevent a problem from occurring that we do not engage in discussion about positive outcomes. Despite this, there are clear positive implications in defining a public health emergency in terms of time. This not only defines the end of heightened support and effort in eliminating a problem, but sets in place a clear target at which efforts can be aimed.

5. Conclusion

Swine Flu and SARS would have called for a PHE declaration if this had been in place. Both were pressed for by external parties, particularly the media. It is thought that the WHO created an emergency for SARS under pressure from the media, and the same occurred with Swine Flu. The emergency was thought to have been declared due to the high death rate possibility and the fear of legal action if not declaring it. A declared emergency is certainly not in the best interest for the public in every case, and in an environment with no defined criteria to state when an emergency is over, it can lead to scenarios such as the polio PHE in 2003. This was an oversight as it was merely an affirmation to the expected polio eradication with continued immunisation, and it was drawn to end after only 2 years. Post-event activities caused the emergency to be reinitiated in 2005.

It is clear that defining the end date of a public health emergency is vital. The time has come for the World Health Organisation to establish concrete guidelines in determining the termination of a public health emergency. There must be specific triggers that show the end, and an external committee of experts should be used to validate it. There is currently no standard, and the emergency alert system has never been used, which gives off the wrong message.