When can we declare the end of the pandemic?

Was there once a pandemic? Joe Biden decided it was time to talk about it in the past tense. The US president assured that the “Covid-19 pandemic is over” in an interview on CBS’ “60 Minutes” on Sunday, September 18.

The “improvised” exit – according to US media – comes days after the same announcement by World Health Organization (WHO) Director Tedros Adhanom Ghebreyesus.

For some, “the end of the pandemic”, for others, a vaccination campaign

The latter announced on Thursday, September 15 that “the end [de la pandémie, NDLR] Optimism is justified by the global death toll from Covid-19. On September 5, 11,118 deaths were reported in a single week, the lowest weekly number since March 2020.

It’s the same accounting logic that led Joe Biden to believe there was no longer a need to talk about a pandemic “even if Covid-19 remained a problem.” The United States rose from more than 3,000 deaths per day at the start of Joe Biden’s mandate to 400 in September, the CDC (Centers for Disease Control and Prevention, America’s main health authority) points out. Critics of Joe Biden’s announcement pointed out that this is still 400 dead.

More importantly, this optimism may be at odds with what is happening in other parts of the world. “It can be worrying to hear about the end of the pandemic in Europe, when several countries are starting campaigns to encourage vaccination this autumn,” admits Yves Kopiters, an epidemiologist at the Free University of Brussels.

In France, the tone is also far from triumphant, with Public Health France warning of an increase in positive cases since early September.

It looks like China is not going to win the fight against Covid-19. There are still more than thirty cities that impose partial or complete restrictions on more than 60 million Chinese.

Between the optimism of some and the caution of others, it’s hard to know where we stand. “The problem is that there is no scientific definition of what it means to end the pandemic,” explains Rachel Piltsch-Loeb, a specialist in public health policy at Harvard American University, who was interviewed by the National Geographic Channel.

The ball is on the court of the World Health Organization

From a formal point of view, “since it is the WHO that declares the start of a pandemic, it is also up to it to decide when it will end,” Mircea Sophonea, an epidemiologist from the University of Montpellier, estimates.

The organization also has a committee of experts who decide every three months from January 2020 on the appropriateness of continuing to qualify the situation as a pandemic. These “wise men” again favored the designation in their latest opinion, published on July 12, 2022.

It is hard to predict whether they will be tainted by the optimism of Joe Biden and Tedros Adhanom Ghebreyesus. In fact, there is no list of precise criteria that will make it possible to predict whether this committee will declare the end of the pandemic in its next opinion, which is expected in mid-October.

The end of the Covid-19 pandemic will not be the end of smallpox in May 1980, when 33^e The World Health Assembly was able to record the complete disappearance of this disease in all countries of the world. “We don’t have the means to aim for the complete elimination of Sars-CoV-2,” asserts Mircea Sophonea.

In the case of Covid-19, the most scientific approach would be “to find when the main criteria for declaring a pandemic – that is, outbreaks on at least three continents – are no longer relevant for Covid. 19”, notes Yves Kopiters.

Each country establishes, in effect, a threshold of virus circulation above which it must declare the presence of an epidemic of the disease to the WHO. For example, this “epidemic threshold” for Covid-19 in France is 98 cases per 100,000 inhabitants.

But the most reliable data is not always enough to achieve unanimity. Thus, “the WHO has been criticized for reporting too late [en mars 2020, NDLR] the start of the Covid-19 pandemic”, Mircha Sophonea notes.

Consequences of the end of the pandemic

For him, the only indicator that would currently make it possible to judge that the end of the pandemic is near would be to “take into account the saturation of the hospital”. Thanks to good vaccination coverage, more effective treatments, and options like Omicron that appear to result in fewer hospitalizations, the impact of Covid-19 on health systems is far less devastating than it was even a year ago.

The fact remains that even considering this factor alone, it is risky to say that the pandemic is over. “It is difficult to predict, in particular, if the next option does not turn out to be more dangerous,” emphasizes the journal Science.

“The decision is made more by political and social criteria than scientific,” said Caroline Buckey, an epidemiologist at Harvard University, in an interview with Science.

It will indeed be necessary to think twice before signaling the end of the pandemic, as this return to normal health will have significant financial and social consequences. Some pharmaceutical companies, such as the US-based Moderna, have vowed not to assert their intellectual property rights over vaccine technology… as long as the Covid-19 pandemic continues. Some emergency programs, such as Covax — an international initiative for equal access to vaccines — “will not be as supported when the pandemic is over,” Science notes. However, the end of the pandemic does not mean the complete eradication of Covid-19… especially in regions – often less affluent regions – where vaccination is slow.

That is why experts interviewed by France 24 do not think that the end of the pandemic will be announced in the near future. The statements of Joe Biden and Tedros Adhanom Ghebreyesus are quite “political statements”, believes Yves Kopiters. Especially in the case of the head of the WHO: “This contradicts the often very pessimistic tone of the organization since the beginning of the pandemic. [inflation, guerre en Ukraine, risque de récession, NDLR] At least the health condition is improving,” he concludes.