There's no formal process under international law or governance for declaring a pandemic over.

For influenza, the post-pandemic phase is defined by a return to seasonal levels, but we don't know (1) if that will occur for COVID19 (albeit likely) & (2) what those levels will be. With the continued transmission of COVID19 and emergence of new variants, we are clearly not in the "pandemic's over" phase. There's clear guidance (again, that can be modified from flu) with what we should be doing

As we wait to hear if the WHO Director-General will declare #monkeypox a Public Health Emergency of International Concern, it’s a good time to reflect:

What happens when a PHEIC is declared?

tldr: 🚨💰🧾🌎⚖️

🧵 1/7 First: 🚨

A PHEIC is a global alert and call to action.

Health matters aren’t necessarily on country leaders’ radars: PHEICs are intended to address this.

2/7

WHO has issued advice to countries on 🌍international traffic🌍 in relation to the omicron variant. It is nuanced and well considered.

Full text here: who.int/news-room/arti…

Key points in 🧵below: WHO commends South Africa🇿🇦 & Botswana🇧🇼 for surveillance and genetic sequencing capacities, transparency, and rapid reporting under the IHR.

WHO calls on all countries to show solidarity w 🇿🇦 & 🇧🇼, & rapid & transparent info sharing, noting omicron likely in more countries🗺️

As Dante wrote in Paradiso, “Fate’s arrow, when expected, travels slow”.
The emergence of concerning variants, arbitrary rather than risk based travel restrictions, global vaccine injustice, ableism in endemicity, are not only our present, but our future w/o political action. Early in the pandemic, those of us in global public health would entreaty “this will be a marathon, not a sprint”.

Some days, it feels as though we’ve entered an ultramarathon with no conditioning.

📰New Study🔬 out in @TheLancet!

By building a moment by moment chronology, we analyze how an outbreak became a pandemic & priorities for international reform.

So excited to share this huge team effort led by the amazing @sudhvir!

Link: thelancet.com/journals/lance…

Explainer🧵1/8 2/8
In this paper, we:
1⃣ build a 50pg moment by moment chronology from outbreak to pandemic
2⃣ identify & analyze 5 key phases of events
3⃣map actions against IHR obligations under international law
4⃣propose 5 key areas for #GlobalHealthLaw reform, inc. IHR & #PandemicTreaty

Some of the big questions we try to teach in Epidemiology for Lawyers, whether students go to a firm, the Hill, WH, judiciary or elsewhere: what principles & processes help us make decisions on limited data & how do we change decisions (but keep trust) as evidence evolves?

https://twitter.com/ezraklein/status/1377620884387725322

Two quick examples:

for the first question,
1) what is the quality of the evidence (systematic review, cohort, case study)
2) is better evidence possible
3) could it do harm to wait or act (e.g. should we apply a precautionary approach)

Unofficial reports so far state that the subtype is H5N8 – this would be a novel influenza subtype in humans.

The IHR require immediate reporting of *any* novel human influenza subtypes as potential PHEICs, no matter how serious.

https://twitter.com/alexandraphelan/status/1363098519117193216

Since 2020, there has been a global H5N8 outbreak among bird populations – wild birds and poultry. Cases have been reported in Saudi Arabia, Russia, Kazakhstan, Netherlands, Germany, Denmark, UK, France, Sweden, India, Japan, Norway, South Korea.

e.g. Estonia's 17 Feb OIE report

Russian has reported seven human cases of avian influenza to @WHO

No confirmation of subtype yet.

No evidence yet of human to human transmission: all cases reported are workers in a poultry plant.

reuters.com/article/us-hea… There have been a few highly pathogenic avian influenza infections (HPAI) across Europe recently in wild birds (@OIEAnimalHealth – WAHIS appears to be down this morning?)

*Public health actions to control new SARS-CoV-2 variants*

Our paper just published in @CellCellPress w wonderful co-authors @NathanGrubaugh @firefoxx66 @JosephFauver & @mugecevik

We describe actions govts should urgently take to protect health.

🧵1/7

cell.com/cell/fulltext/… New SARS-CoV-2 variants of concern will continue to emerge: exacerbating already crippling outbreaks & potentially reducing efficacy of some vaccines, cause increased rates of reinfections and prolonging the pandemic.

2/7

Today, @ThinkGlobalHlth is celebrating its one year anniversary. @RebeccaKatz5 & I were fortunate enough to be invited to write a piece for this new @CFR_org blog, led by @TomBollyky.

Some reflections from that piece on why global governance matters.
thinkglobalhealth.org/article/why-gl… From the outset, it was obvious that global governance was about to be seriously tested. Unfortunately, over this pandemic we've seen that play out to be the case – not only globally but also national governance.

I disagree with folks dismissing the implications of the UK variant of concern.

While individual behaviors to avoid transmission may not change, the impact at the population level is serious: hospitals are already at capacity.

Quick thread
/1 Any factor that ramps up transmission (biological or behavioral) amplifies cases, and as a result, severe cases and deaths. When hospitals hit capacity, cases that could have been treated successfully will be triaged along increasingly stringent crisis standards of care.
/2

Public Health England has just released their updated report on the UK #SARSCoV2 variant

"Investigation of novel SARS-CoV-2 variant: Variant of Concern 202012/01"

I'll do a quick summary thread below & link to report: A cluster was identified & used to assess increasing incidence of the Variant of Concern (designated as such 18 Dec) in Kent, UK:
- 4% (255/6130) of Kent cases had available genomes
- in Kent: 117 genomically similar cases identified (10-19 Nov)
- in UK: 962 genomes of VoC(8 Dec)

A lot of good discussion today about what we know and don't know about the new #SARSCoV2 variant in the UK.

But what does this mean (if anything) for government responses & public health law control measures, even if greater transmissibility is confirmed?

Quick notes (1/7) Firstly, the virus is already sufficiently transmissible to be a concern. As others have noted, already important critical public health measures (avoiding crowds, social distancing, mask wearing, hand washing) will address variants that emerge:
(2/7)

https://twitter.com/trishgreenhalgh/status/1340677485856514050?s=20

Vaccine news that may not be covered outside of Australia:

The University of Queensland/CSL #covid19 vaccine trial has reportedly been abandoned for really interesting reasons, with one less potential vaccine for global COVAX Facility pool.

Quick thread:
smh.com.au/politics/feder… The UQ/CSL vaccine (V451) uses a molecular clamp vaccine platform with the COVID-19 spike protein: the clamp "locks" the spike protein to be more stable for purification & manufacture. It contains a small component derived from HIV that cannot infect people & poses no health risk

With the vaccine Executive Order now up, President Trump has ordered that "Americans" have priority to "US Govt COVDI19 Vaccines".

I want to push back on some arguments dismissing the risk of this as there are very concerning impacts.

whitehouse.gov/presidential-a… United States Government COVID-19 Vaccines are defined in the EO as "COVID-19 vaccines developed in the United States or procured by the United States Government"

This does not limit the scope of the EO to those purchased under APAs, but includes vaccines developed here.

This is a huge drop of China #COVID19 documents from @npwcnn. Unfortunately, this leak confirms points I & other China, health, law folks have said since Jan.

I'm going to summarize some of the key findings in 🧵below

Here's full report:
edition.cnn.com/2020/11/30/asi… Finding 1: Hubei (Wuhan's province) had 20 times increase in "influenza cases" in Dec. High number of "unknown cause" is flag: flu relatively easy to confirm if tested. Also not clear how many confirmed influenza, & if so, if/what samples or GSD was shared w @WHO GISRS.
🧵2/10

Lovely piece from @guardian on our recent publication in Proc @royalsociety B "What would it take to describe the global diversity of parasites?"

It may not be apparent but this is also a story of rectifying colonial "exploration narratives".

🧵1/6

theguardian.com/environment/20… To follow the article, here's a great explainer thread about our piece by @wormmaps about the science of estimating how many uncounted parasites there may be (including the Brothers Grimm & uncountable things):

🧵2/6

https ://twitter.com/wormmaps/status/1329070889372176384?s=20

Failures in US leadership mean Americans face tough decisions with Festive Season. In Jan, China faced similar choices but w more uncertainty).

A short thread comparing & drawing lessons between:
– January China 🧧Lunar New Year🧧
– November United States 🦃Thanksgiving🦃

1/13 Starting with some case count comparisons between Lunar New Year in China & now in the US:

– 254.3 cases per day: China (Jan 25)
– 135,714.3 cases per day: US (Nov 12)

2/13

Weekend Reading?

🌎New Publication🌏
The first in the ILIAID Consortium White Paper series on IHR Reform:

"Reforming the Declaration Power for Global Health Emergencies" by @clarewenham @alexandraphelan @MarkRTurner Sam Halabi.

Available here: georgetown.box.com/s/w0u7k6dwb740…

(1/7) Why did we write this? In light of COVID19, suggestions to reform the mechanism for declaring a public health emergency of international concern (PHEIC) have gained renewed attention & political will. Any substantial reform of PHEICs will likely require amendment to the IHR (2/7)

We've warned of pandemics (inc. CoV) but govts have failed to act.

Special Rapporteur Prof David Boyd "Human rights have been a catalyst for the types of transformative changes that scientists are saying that we need"

(THREAD)
#PandemicRecovery @Cambridge_Uni @BennettInst "The achilles heel of international environmental law... is a lack of enforcement mechanisms, and human rights overcomes [that challenge]" David Boyd
#PandemicRecovery @Cambridge_Uni @BennettInst

I completely agree & have written more about this here:
opil.ouplaw.com/view/10.1093/l…

In past pandemic planning scenarios, we war game what would happen if the president and VP are both unable to fulfill their constitutional duties due to an infectious disease.

The Presidency, the Agencies, and Congress all have clear processes (set out below) but...
(1/5)

https://twitter.com/JonLemire/status/1314301895075340299

⏹️Presidency⏹️

Presidential Succession Act (1947) sets out order:
1⃣Vice President (M. Pence)
2⃣Speaker of the House (N. Pelosi)
3⃣Speaker pro tempore (C. Grassley)

Then Cabinet members on dept creation order starting with4⃣State (M. Pompeo)5⃣Treasury (S. Mnuchin)

(2/5)