Attachments
Part l. Overview and objectives
Situation overview
More than two years since the first SARS-CoV-2 infections were reported, the COVID-19 pandemic remains an acute global emergency. The emergence and rapid spread of the Omicron Variant of Concern (VOC; see Box 1) towards the end of 2021 precipitated an acceleration of SARSCoV-2 transmission worldwide, at an intensity the world had not yet seen. More than 143 million new cases were reported globally in the first two months of 2022 alone – one-third of the 433 million cases that had been reported up to 28 February since the onset of the pandemic. The pandemic is not over, although COVID-19 is now affecting countries in very different ways.
Almost six million deaths from COVID-19 had been reported to WHO up to the end of February 2022: an unacceptably high number that is almost certainly an underestimate. In the first week of February alone, more than 75 000 people were reported to have lost their lives to COVID-19, an unacceptably high number that we know is an underestimate. Many thousands more will be affected by long-lasting and debilitating sequelae.
COVID-19 continues to have a profound impact on global health, causing death and severe disease on an unacceptable scale. Although there is heterogeneity between regions, overall transmission remains high, and increases the risk of new variants.
In September 2021, WHO outlined the risk factors that could prolong the COVID-19 pandemic, including the “possibility that new variants will emerge with greater transmissibility and lower susceptibility to current vaccines; the inconsistent application of public health and social measures; the continued politicization and mixed messaging around proven and effective public health interventions; the global prevalence of misinformation about COVID-19 and COVID-19 tools such as vaccines; and crucially, inequitable access to and capacity to utilize COVID-19 tools such as vaccines”. To a large extent, our collective failure to adequately address these and other (figure 1) drivers of transmission and impact has resulted in the continuation and, in some cases, deterioration of the COVID-19 pandemic. The choices we all make now, both as individuals and collectively, will determine when the pandemic ends.
WHO’s first global Strategic Preparedness, Readiness and Response Plan (SPRP) was published on 4 February 2020, and outlined the essential steps needed at global, national and local levels to suppress transmission of COVID-19, reduce exposure, protect the vulnerable and save lives.
The SPRP 2021 updated the strategy to take account of new knowledge and more effective tools developed over the preceding year. In this document for 2022,
WHO sets out a number of key strategic adjustments that, if implemented rapidly and consistently at national, regional, and global levels, will enable the world to end the acute phase of the pandemic. While recovery and the strengthening of the global health emergency preparedness and response architecture are beyond the scope of this document, it should be noted nevertheless that the capacities and adjustments necessary to end the acute phase of the COVID-19 pandemic can and should lay the foundations for a future in which the world is prepared to prevent, detect and respond to pandemic threats.
Drivers of transmission and impact
In order to end the COVID-19 global emergency we must address the primary factors that are driving transmission of the SARS-CoV-2 virus and driving the direct and indirect impacts of COVID-19 disease (Box 2). Some factors drive both transmission and impact, and many of the factors interact to multiply their effects.
Although it is not possible to eliminate SARS-CoV-2, by addressing the drivers of transmission and disease impact in every country we can end the global COVID-19 emergency in 2022.
At national level, the relative importance of each of the drivers of transmission and disease impact is largely dependent on country-specific and local contextual factors, including:
• Local epidemiology, and the ability to adapt public health measures dynamically in response to public health intelligence • Demographics and prevalence of risk factors for disease severity
• Population immunity (vaccine-derived and infectionderived) and susceptibility
• Access to use of life-saving tools
• Leadership and communication
• Engagement of communities with the response
• The resilience and capacity of health systems to respond and surge.
Planning scenarios
The complex interplay between all the above factors, and the dynamic changes in their relative importance in different contexts over time, means that an effective strategy to end the global COVID-19 emergency must be multilayered and agile. It must be flexible enough to account for changes in immunological and virological drivers of impact and transmission that are both largely outside our control and extremely hard to predict on the basis of current evidence and predictive tools.
For planning purposes, we can envisage three potential scenarios regarding viral evolution and human immunity over the next 12 months: a base case, a best case, and a worst case (figure 1).
The base case is our current working model, and is based on what we know about the duration of vaccine-derived and infection-derived immunity, the natural history of SARS-CoV-2 and its evolution over the past two years, and our knowledge of other respiratory viruses. It should be acknowledged, however, that there is a high degree of uncertainty attached to all scenarios, and we must therefore build in the flexibility to adapt to rapid and dynamic changes in viral transmission, disease severity, and their impact on individual and population-level immunity.
Another potential scenario to be kept in mind is the emergence of an essentially new SARS-CoV-2 virus. This could be through a new emergence from a pre-existing or newly established animal reservoir, or due to a recombination event in which a patient co-infected with two separate variants of SARS-CoV-2 produces new infectious viral particles that have genetic characteristics shared with both parent lineages. This scenario would effectively be a reset, with a completely susceptible global population. This scenario is not explicitly included as a planning scenario, but should be considered a background threat, and all COVID-19 response and readiness capacities should be understood to yield a resilience dividend pertaining to that threat.