For most Australians, the words “COVID pandemic” evoke memories of lockdowns, daily case alerts, and the tussle for rapid antigen test kits.
With those days over, Australians have been “living with COVID” for many years now. So why is it still considered a pandemic?
Despite lifting the public health emergency status, the World Health Organization (WHO) still refers to COVID as a pandemic on its website and lists it under its current health emergencies, alongside other disease outbreaks, disasters and humanitarian crises.
What is the current advice on COVID?
In January 2020, as cases spread across the globe, WHO declared COVID a ‘ emergency of international concern’ — which is an “extraordinary event” that constitutes an international public health risk, according to International Health Regulations.
The International Health Regulations are an instrument of international law that create rights and obligations for participating nations.
In May 2023, WHO declared an end to the public health emergency.
WHO’s Director-General Tedros Adhanom Ghebreyesus said at the time that he had “great hope” but also emphasised the ongoing threat of the disease, saying it was still a “global health threat”.
“This virus is here to stay. It is still killing, and it’s still changing. The risk remains of new variants emerging that cause new surges in cases and deaths,” he said.
The total global death toll of COVID as reported by WHO stands at 7.1 million, including 25,236 Australians.
Professor Paul Griffin, an infectious diseases researcher from the University of Queensland, said that while some experts argue that COVID should no longer be considered a pandemic, he believes public health messaging needs to walk a fine line.
“It is a little bit subjective,” Griffin told SBS News.
“But what is clear is that there’s a lot of ongoing activity, so we certainly don’t want to want to try and give the impression that COVID is no longer an issue.”
What is a pandemic?
An outbreak of disease falls into one of three categories that describes the number of cases and geographical area affected: endemic, epidemic or pandemic.
Endemic refers to an outbreak confined to a particular geographical area, epidemic refers to a more widespread outbreak, such as one affecting an entire nation and a pandemic describes an epidemic affecting the whole world.
COVID “very easily” fit the definition of a pandemic when it started spreading internationally, Griffin said.
While WHO can declare a public health emergency of international concern, it can not define the start or end of a pandemic under the International Health Regulations.
When will the pandemic end?
Griffin said it is very difficult to establish when COVID will no longer fit the definition of a pandemic and instead be defined as an epidemic or endemic.
“There’s not an established endemic pattern for COVID because it is obviously a new novel pathogen, so the level of activity we would expect as ‘normal’ is a bit hard to know,” he said.
While the flu is experienced routinely around the world and WHO estimates one billion people are infected every year, Griffin said it isn’t considered a pandemic because of the patterns of infection.
“We do see a flu epidemic every year essentially because of the seasonality. So, in winter in most parts of the world there’ll be an increase in cases above what would be expected or normal,” he said.
However, the H1N1 flu — otherwise known as swine flu — was declared a pandemic by WHO in June 2009 after 74 countries around the world detected cases.
The H1N1 pandemic was declared over in August 2010 as cases tapered off and the virus began to circulate with seasonal influenza around the world.
While it hasn’t happened yet, Griffin said it may get to the point where COVID is considered endemic with an expected level of infections every year and the definition would only shift when a new subvariant increases the number of infections.
Griffin said continuing to define COVID as a pandemic and its listing as an continuing emergency by WHO is an attempt to “strike a balance” around public health communication.
“It is a real difficult balance because if we try and escalate people’s perception of risk — which we want to do in some ways so that they do things like get vaccinated and get tested — there’s an element of criticism and people will suggest we’re being alarmist,” he said.
“But if we are reassuring, then there’s also a lot of criticism that we’re not taking it seriously enough and being complacent.”
Griffin said that while it may cause some confusion, the WHO is ultimately trying to get the “perception of risk just right”.
“It is indicating that this is something that is still significant and we still want people to do the right thing,” he said.
