Commentary: The costly lesson from COVID-19 – elimination should be default strategy for future pandemics


If elimination is ultimately not successful or justifiable, an organised transition to another strategy (suppression or mitigation) should be considered. Processes for managing these transitions can draw on experience from the current pandemic.


The most recently declared public health emergency of international concern is mpox (formerly known as monkeypox). Under our proposed change to the International Health Regulations, the WHO would have been required to assign a response strategy to this disease.

Elimination again makes sense as a default approach. That is what countries around the world have effectively been doing. And this approach appears to be working.

The other current public health emergency of international concern is poliomyelitis. Unlike COVID-19 and mpox, this disease is already subject to a global eradication goal.

A further benefit of the elimination strategy is that it supports strengthening of health system infrastructure in low and middle-income countries. This capacity building has contributed to the elimination of periodic Ebola outbreaks in Africa, which have been designated as public health emergencies of international concern in 2014 to 2016 and 2019 to 2020.

It could also support elimination of mpox, an increasing threat in Africa.

Upgraded International Health Regulations could stimulate a huge global investment in infrastructure to stop epidemics at source and improve surveillance capacity. These capacities are critical given the range of future pandemic scenarios, including the threat from bioweapons with advances in synthetic biology.


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