Why Dr Tedros could consider calling Trump’s withdrawal from WHO a PHEIC

In 2005, in the aftermath of the SARS outbreak, the international community concluded that the old health regulations could no longer help the global community respond promptly to health threats, and they needed an update. The world had changed too much from the era of 1969 when the limited amount of traffic of people, animals and goods globally would only require a fixed list of a handful of pathogens on the alert list.?

The revised International Health Regulations (IHR) in 2005 introduced a broad scope that included the old, familiar diseases that could shape epidemics, but also events where no diagnosis could be made (yet).

According to the IHR 2005, the IHR Emergency Committee could provide technical advice to the WHO Director-General in the context of a so-called “public health emergency of international concern” (PHEIC). A PHEIC is defined as

... 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.

When a public health event is declared a PHEIC, the WHO develops and recommends critical public health measures.

The definition of a PHEIC implies that a situation answers 'yes' to each of the following three questions:?

1. Is the event serious, sudden, unusual or unexpected?
2. Does the ‘event’ carry implications for public health beyond the affected country's national border? In other words, does it pose a risk to other countries through international spread?
3. Does this event require immediate international action through a coordinated response?

Until now, only disease outbreaks have been designated a PHEIC. However, extraordinary times may demand an unusual interpretation of the regulation text.

We'd like to share our views and argue that the withdrawal from the WHO by the Government of the USA is an event that could in fact be considered a Public Health Emergency of International Concern.

In response to the three questions:

1. The “event” is definitely unusual and extraordinary by the virtue that it is unprecedented and that the impact will be significant. No Member State has ever fully withdrawn from the World Health Organization (WHO) since its founding in 1948. Although there have been instances where governments discussed or initiated withdrawal procedures (for example, the United States under the Trump administration in 2020), no other country has completed a formal withdrawal.
2. Yes, it poses a risk to other countries through international spread. It is, unfortunately, likely that the decision to “withdraw from WHO” is contagious and can spread to other countries. Shortly after President Trump signed the executive order to withdraw from the WHO, Argentina’s president Milei also ordered the foreign minister to withdraw Argentina’s participation in WHO. This withdrawal and its potential precedent to other countries is a sheer undermining of international agreements and collaboration needed for pandemic preparedness, as well as for the detection and response to global public health threats. Furthermore, the consequences of this ‘event’ can affect all countries, as they will be impacted when WHO programmes on the prevention and control of infectious diseases are financially hit. The impact will be measurable by an increased incidence of diseases under these control programmes, which will undoubtedly include increased risk of cross-border spread. The USA has been one of the largest donors to the World Health Organization, supporting a range of crucial current WHO programmes, including polio eradication, global health emergencies and outbreak response, and programmes on HIV, tuberculosis, malaria, maternal, newborn and child health. The interruption of these programmes will have a significant global public health impact by any measure, as the incidence of infectious diseases may increase due to the disruption of the programs, posing an international direct international threat.?
3. Yes, this event requires an immediate coordinated response. Member States, NGO’s and other stakeholders will have to come together and support the WHO in finding ways to replace the funding, and perhaps even their governance, to keep these essential public health programmes operational. In addition, we believe leaders must step up at all levels, including regional blocks like the EU, national politicians, ministers of health and foreign affairs, public health leaders, etc. Coordination is needed across regions, countries and sectors.

We believe the event of the USA withdrawing from the WHO constitutes a “public health emergency of international concern” as it constitutes a public health risk to other WHO Member States through the international spread of disease and requires a coordinated global response. Therefore, we call to our national and international political and public health leaders to treat this event as a Public Health Emergency of International Concern.?

Infectious diseases do not respect borders. In order to detect public health threats and respond to them accordingly, a strong, reliable and committed network is essential to fulfil the WHO's mission: “to promote health, keep the world safe and serve the vulnerable, with measurable impact for people at country level”.

Arnold Bosman , MD, MPH; epidemiologist, director of Transmissible Public Health Learning Support, the Netherlands

Alma Tostmann , PhD; epidemiologist (EPIET), Radboud University Medical Centre, Nijmegen, The Netherlands

Ignacio Garitano Gutiérrez , MD, MSc; epidemiologist (EPIET), family physician, obstetrician and gynaecologist, University of the Basque Country, deputy director of Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain