Opinion: In nature, there is no sharp dividing line between pandemic and non-pandemic. In policy, we need certainty, so we create an artificial distinction to determine when we’re obliged to take action
The end, it seems, is near. As countries around the globe start clawing back public health measures, it appears the pandemic is finally almost over after two long years.
Or two years and one day, to be exact, for it was on March 11, 2020, that World Health Organization Director-General Tedros Adhanom Ghebreyesus “officially” declared COVID-19 a pandemic.
Many public health experts thought Tedros a little late in his pronouncement, and suspected politics, rather than science, played a role in his delayed declaration. Now, at the other end of the pandemic, experts are similarly concerned that political considerations are driving our decisions to say “sayonara” to public health measures.
And in both cases, the experts would be right. Non-scientific factors have always played a role in the designation of pandemics, and that’s not going to change because a WHO declaration is inherently a legal, moral and political (normative) act, not a scientific (descriptive) fact.
As an article in Science magazine details, Tedros’s “official” declaration on March 11 was, in fact, nothing of the sort: The official one — the one with normative force — was made on Jan. 30, 2020, when Tedros accepted the recommendation of the WHO Emergency Committee and declared COVID a Public Health Emergency of International Concern (PHEIC).
With that declaration, WHO members were encouraged to follow the organization’s advice on COVID, and to mobilize international health measures, such as COVAX, which distributes vaccines to developing countries.
And when the WHO declares that the pandemic has ended — or, more accurately, when it decides not to renew the PHEIC declaration — those expectations and measures will likely cease.
The normative nature of the declaration is therefore inescapable, and that means politics will always play a role. Indeed, since the PHEIC framework was created in 2005, a declaration has been issued six times (for H1N1 influenza, polio, Zika, COVID, and two Ebola outbreaks), and in every case the declaration was condemned for permitting politics to intrude.
It is therefore worth trying to improve the situation, especially given what’s at stake at both ends of a pandemic. And one of the most frequently criticized aspects of the declaration is its binary nature: Either a PHEIC is issued or it isn’t.
That, of course, doesn’t square with scientific reality. Infections vary in how prevalent and widespread they are, but to say there is some magic barrier they must cross to qualify as a pandemic is to draw lines in the sand where none exist in nature.
And that highlights the difference between the legal and the scientific, the normative and the descriptive. In nature, things exist on a continuum, with no sharp dividing line between pandemic and non-pandemic. In law and policy, we need certainty, so we create binaries — we create an artificial distinction between pandemic and non-pandemic to determine when we are obliged to take action.
Despite that, critics have suggested modifying the PHEIC system by adding an intermediate level to the binary choice of either declaring or not declaring a pandemic.
Tedros himself suggested a similar modification in his Jan. 30 statement, advising that the WHO create a warning to member states that an international response might be needed to an infectious disease not yet considered a pandemic.
This “traffic light” approach of adding a yellow warning light to the red and green of declaring or not declaring a PHEIC could effectively avoid some of the problems of the current regime, which typically results in the international community either doing something or nothing.
But since many states don’t fulfill their obligations even when a PHEIC is declared, the traffic light approach suffers from the same problem as the binary model — the problem being one familiar to international law, ie, how to compel states to act.
A recent Lancet article argues, therefore, that we tie funding directly to the PHEIC and require members to explain how they will contribute to the effort to control the pandemic. While not a panacea, this at least recognizes that declaring when pandemics begin — or when they end — is ultimately a normative matter, not a scientific one.
None of this will prevent states from declaring that the end is near, or that the end is here. But those, too, are policy decisions, and the political side of life is always a messy affair.