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Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
1. 2009 Novel influenza A (H1N1) pandemic: Declared on 25 April 2009; the first PHEIC under the International Health Regulations (2005).
2. 2014 polio eradication: Declared on 5 May 2014; remains ongoing due to continued international transmission risks.
3. 2014 Ebola outbreak in West Africa: Declared on 8 August 2014; a large epidemic affecting Guinea, Sierra Leone, and Liberia.
4. 2016 Zika virus outbreak: Declared on 1 February 2016; linked to clusters of microcephaly and neurological disorders, the first mosquito-borne disease declared a PHEIC.
5. 2019 Ebola outbreak in Democratic Republic of Congo (Kivu outbreak): Declared on 17 July 2019; the second Ebola-related PHEIC.
6. 2019 COVID-19 (caused by SARS-CoV-2): Declared on 30 January 2020; became a global pandemic, with the PHEIC status lifted on 5 May 2023.
7. 2022 Mpox (formerly “monkeypox”) multi-country outbreak: Declared on 23 July 2022; PHEIC ended in May 2023.
8. 2024 Mpox (new clade outbreak in Africa): Declared on 14 August 2024; a renewed PHEIC declaration for a newly emerging clade in Africa.Why do these outbreaks raise such concerns?
Outbreaks are declared as Public Health Emergencies of International Concern (PHEIC) when they pose a serious, sudden, unusual, or unexpected threat that may spread internationally and require a coordinated global response.Here are the key reasons why such outbreaks raise international concern:
1. Risk of International Spread
Diseases like COVID-19, H1N1, and Ebola can easily cross borders through travel and trade. This makes containment at the national level alone ineffective.2. High Morbidity and Mortality
Many PHEIC diseases cause severe illness and death in large numbers (e.g., Ebola’s ~50% fatality rate, COVID-19’s global death toll in millions). High fatality rates increase urgency for international action.3. Lack of Immunity, Vaccines, or Treatments
When diseases are novel (like COVID-19 or Zika), populations have little to no immunity and limited medical countermeasures. Rapid research and global coordination become crucial.4. Severe Socio-Economic Impact
Outbreaks disrupt economies, education, and healthcare systems. COVID-19, for example, caused massive economic losses and supply chain collapse.5. Potential for Rapid Transmission
Some pathogens (like influenza or COVID-19) spread through air or contact, allowing exponential growth of cases. Even a small outbreak can quickly become global.6. Weak Health Systems in Affected Areas
If outbreaks start in regions with limited health infrastructure, they can overwhelm hospitals and delay detection. This raises the risk of uncontrolled spread.7. Social and Political Consequences
Misinformation, fear, and stigma often accompany outbreaks (e.g., Zika and birth defects, Ebola and burial customs). These complicate response efforts and require international support.In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
Yes, there are diseases and conditions that experts believe could in the future reach the threshold for a World Health Organization (WHO) Public Health Emergency of International Concern (PHEIC). Influenza virus is an example for such condition.Influenza viruses mutate frequently, and they are well known for their pandemic potential. Some avian flu strains (H5, H7 subtypes) have infected humans, and the concern is if they adapt for more efficient human-to-human transmission. Influenza spreads easily via respiratory route, making control harder. Even though we have vaccines and treatments for seasonal flu, a novel strain could render them much less effective or leave large immunity gaps. Because of the inherent risk of aerosol spread + global travel, an influenza event ticks many PHEIC-criteria.
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List of the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)? Why do these outbreaks raise such concerns?
Since 2005, eight disease outbreaks have been declared as Public Health Emergencies of International Concern (PHEIC) under the IHR 2005. These include:
1. H1N1 Influenza Pandemic (Swine Flu): Declared on April 25, 2009, and ended in August 2010. This outbreak rasied concern by a rapidly spreading novel influenza virus that infected millions worldwide, raising fears of severe global impact.
2. Wild Poliovirus (Polio): Declared on May 5, 2014, but it’s still ongoing as of 2025. This outbreak raised concern by due to the re-emergence and international spread of wild poliovirus in areas thought to be near eradication, threatening global progress toward elimination.
3. Ebola Virus Disease (West Africa outbreak): Declared on August 8, 2014, and ended on March 29, 2016. This outbreak raised concern by devastating epidemic in Guinea, Liberia, and Sierra Leone that caused over 11,000 deaths and exposed weaknesses in international outbreak response systems.
4. Zika Virus Epidemic: Declared on February 1, 2016, and ended on November 18, 2016. This outbreak raised concern because of its association with severe birth defects, including microcephaly, and its rapid spread across the Americas.
5. Ebola Virus Disease (Democratic Republic of Congo – Kivu outbreak): Declared on July 17, 2019, and ended on June 26, 2020. This outbreak raised concern due to high case fatality rates, ongoing conflict in affected areas, and risk of cross-border transmission.
6. Coronavirus Disease 2019 (COVID-19) Pandemic: Declared on January 30, 2020, and ended on May 5, 2023. The outbreak raised concerb by leading to widespread morbidity, mortality, and socioeconomic disruption.
7. Monkeypox (Mpox) Outbreak: Declared on July 23, 2022, and ended on May 11, 2023. The outbreak raised concern due to emergence in multiple non-endemic countries, highlighting global vulnerability to zoonotic infections.
8. Monkeypox (Mpox) Re-emergence: Declared again on August 14, 2024, following new outbreaks in Central and East Africa. This outbreak raised concern due to the rising number of cases across several regions, reflecting persistent transmission and the need for coordinated control efforts.Overall, these outbreaks raised global concern because they met the core PHEIC criteria: they posed a public health risk, had the significant risk for international spread, international trade and travel restrictions, as well as required a coordinated international response.
In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
In my opinion, any disease that is highly infectious, difficult to detect in its early stages, and capable of spreading across borders has the potential to trigger a Public Health Emergency of International Concern (PHEIC) in the future. One example is avian influenza, which remains a major concern due to its ongoing mutations (strains adaptations) and increasing presence among both animal and human populations. These changes raise the risk of the virus adapting to spread more easily between humans, which could create conditions for another global health emergency. Therefore, I would say that it is essential to recognize the interconnection between humans, animals, and the environment, One Health approach, as a key perspective in anticipating and preventing future PHEICs.
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Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
The list of diseases that declared as PHEIC as below;
1) In 2009; H1N1 Pandemic,
2) In 2014; Ebola virus in western Africa
3) In 2016, Zika Virus Epidemic
4) In 2019 & 2020; COVID-19 PandemicWhy do these outbreaks raise such concerns?
This outbreak raise such concerns based on the following four criteria;
1) impact on public health serious
2) unexpected or unusual event
3) significant spread to international
4) risk of any restriction in travel and tradeIn your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
Regarding to my opinion; According to world Malaria report 2024 by WHO In south east Asia including Myanmar, It found out one or more indigenous cases from 2022 to 2023, Malaria may lead to potentially PHEIC in the future if we could not control the cases especially case transmitted to boarder countries because the cases gradually increased after 2021. People are fleeing to cross boarder. In report, it described as ” In Thailand, bordering Myanmar, the number of reported indigenous cases has more than tripled between 2021 (2426 cases) and 2023 (9169 cases) (30), and reported imported cases to Thailand also significantly increased over the same period (2021–2023), from 800 to 7276 cases”
Sources for world malaria report 2024 by WHO:
https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2024 -
Outbreaks declared as PHEIC
1. 2009 H1N1 influenza pandemic (“swine-flu”) in 2009
2. Ebola virus disease in West Africa outbreak during 2014-2016
3. Zika virus and associated clusters of microcephaly/neurological disorders in 2016
4. Coronavirus disease 2019 (COVID-19) in 2020Why do PHEICs raise such concerns?
Here are the major reasons why a PHEIC declaration is so significant:
1. International spread risk: If a pathogen in one country can spread to others (through travel, migration, trade) and threaten global health, that elevates the concern. Because of the connectivity of modern travel, local outbreaks can become international very fast.
2. Unexpected behavior: such emergencies involve either a new pathogen or a known pathogen behaving in an unusual way (e.g., new transmission routes, new geography, new risk groups).
3. Seriousness of health impact: The outbreak must pose a significant threat, such as high morbidity or mortality potential, large numbers of people affected, or severe complications. For example, COVID-19 caused large global disruption, health system strain, and many deaths.
4. Need for coordinated international response: A key part is that the event requires action beyond individual national responses, e.g., coordination, resource mobilization, global surveillance, travel/trade considerations, research acceleration (vaccines/therapeutics), etc.
5. Public health systems & global equity: Many PHEICs highlight the vulnerability of weaker health systems, capacity gaps, and the need to support countries that may be underserved. The declaration helps direct resources and attention where needed.
Because of all of the above, a PHEIC is more than a label: it’s a trigger for enhanced global preparedness, response coordination, surveillance, research, and resource mobilization.What disease or condition could become a PHEIC in the future — and why
In my opinion, a likely future PHEIC could arise from a novel influenza virus originating in animals (such as avian or swine strains) that mutates to allow efficient human-to-human transmission. For these reasons, influenza viruses evolve rapidly, cross species barriers easily, and spread quickly through global travel. If a new strain emerges against which humans have little or no immunity, it could cause widespread illness and death before vaccines or treatments are available. Such a scenario would meet all PHEIC criteria. -
1. Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
a. H1N1 Influenza (2009): A global swine flu pandemic that spread rapidly, causing widespread concern.
b. Polio (2014): Declared due to outbreaks in countries where vaccination rates were low, risking further international spread.
c. Ebola (2014): A highly fatal disease with major outbreaks in Africa, raising fears of global transmission.
d. Zika Virus (2016): Caused birth defects like microcephaly and spread to many countries, particularly in the Americas.
e. Ebola (2019): Another Ebola outbreak in the Democratic Republic of the Congo, which was declared a PHEIC due to its risk of international spread.
f. COVID-19 (2020): A novel coronavirus that rapidly spread worldwide, causing a global pandemic.
g. Monkeypox (2022): An outbreak outside its typical regions, raising concerns about its international spread and potential for higher transmission.2. Why do these outbreaks raise concerns?
_Global spread: Diseases can spread across borders quickly, especially with international travel, making containment difficult.
_High mortality and morbidity: Some diseases like Ebola have high fatality rates, while others like COVID-19 cause widespread illness.
_Burden on healthcare systems: Outbreaks can overwhelm hospitals and medical resources leading to shortages and higher mortality.
_Economic disruption: Outbreaks can close businesses, limit travel, and slow down economies, as seen with COVID-19.
_Emerging pathogens: New diseases, like COVID-19, may have no immediate treatments or vaccines, making them harder to manage.
_Potential for global impact: These diseases have the potential to turn into pandemics if not quickly controlled.3. In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
In my opinion, the antimicrobial resistance may lead to PHEIC in the future. Due to the limited knowledge of the general population and lack of effective preventive measures such as some countries including Myanmar that lead the bacteria becoming resistant to antibiotics. This could lead to un-treatable infections, posing a serious global health threat. -
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Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
1. H1N1 Pandemic: The infection started from North America in April and WHO declared a pandemic in June 2009, a total of 74 countries and territories had reported laboratory confirmed infections
2. Ebola:It started in Guinea then quickly spread to neighbouring countries Sierra Leone and Liberia. In August 2014, WHO declared the outbreak a Public Health Emergency of International Concern.
3. Zika: The infection was started in Brazil since 2015. After getting the transmitted reports from 86 countries, in 2016, WHO declared that the mosquito transmitted Zika infection as Public Health Emergency of International Concern
4. COVID 19: The novel coronavirus, known as COVID-19, has spread from the People’s Republic of China to 20 other countries in 2019
On 30 January 2020 following the recommendations of the Emergency Committee, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).
In May 2023, COVID is defined as no longer PHEIC and WHO stated that the virus will stay with us for many years.5. MPox: The upsurge of MPox infection in Demographic Republic of Congo and nearby countries was declared as PHEIC in August 2024.
Why do these outbreaks raise such concerns?
1. All these outbreaks caused high morbidity and mortalities for the population. The consequences of those infections are still under research and caused high DALYs.
2. The pathogen is highly transmissible and required external helps to control and preventive measures.
3. Some pathogens are new strain and some are emerging diseases, so the investigation and treatment methods are not ready. This cause panic situation among the community.
4. Due to globalization nature, the infection can easily be imported between countries. This led to pandemic and affected for travels and trades, impacting the countries’ economics and development.In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
From my opinion, the cholera may potentially lead to PHEIC in the future.
According to WHO, in 2024, there are 60 countries that reported cholera cases. The burden of the disease increased when compared to 2023 and 98% of all reported cases are from Africa, the Middle East, and Asia.
[Cholera upsurge https://share.google/EyZpXjb5pz19a2Ydo%5D
Due to unexpected occutof natural and man-made disasters, the basic sanitation infrastructures are damaging and will be difficult to access clean water. Increasing poverty, climate change, conflicts and misuse of antimicrobial drugs are also risk factors.
Not all countries have no adequate vaccines and cholera tools for measures and this is one of the disease to be monitored in resource poor regions. -
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1. Which outbreaks were declared as PHEIC?
From what I read in the documents, WHO has declared these major ones:2009 H1N1 (Swine Flu) – This was declared in April 2009 and lasted until August 2010
2014 Polio – Still ongoing actually, they reassess it every 3 months
2014 Ebola in West Africa – This was really serious – over 28,600 people infected and 11,325 deaths before it ended in 2016
2015-2016 Zika virus – Lasted about 10 months
2018-19 Ebola in Kivu – Another Ebola outbreak, ended in June 2020
COVID-19 – Obviously we all know about this one!2. Why do these outbreaks raise such concerns?
So basically, for something to become a PHEIC, it needs to meet at least 2 out of 4 criteria:Is it causing serious public health impact?
Is it unusual or unexpected?
Can it spread internationally?
Will it affect trade or travel?Like with H1N1, it spread super fast across borders. Ebola had those scary high death rates and needed help from multiple countries. Zika was linked to birth defects which freaked everyone out. These weren’t just local problems – they affected multiple countries and needed coordinated international responses.
3. What do I think could be the next PHEIC?
Honestly? I’m worried about antibiotic-resistant bacteria – like those “superbug” infections we keep hearing about.Here’s my reasoning:
They’re getting more common and scarier – some bacteria now resist ALL available antibiotics. That’s terrifying! They spread easily through hospitals, travel, and even through our food supply. And if we can’t treat basic infections anymore, even minor surgeries could become life-threatening.I’d also keep an eye on diseases spreading because of climate change. As the planet warms up, mosquitoes and ticks are moving into new areas where they’ve never been before. We might see dengue or malaria popping up in places that never had to deal with them.
What do you guys think? Do you agree, or do you see other threats we should be watching out for? 😃
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Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
The Seven PHEIC according to IHR are as belows;
1. In 2009, H1N1 Influenza (Swine Flu) Declared May 2009 and ended Aug 2010. It originated in Mexico/USA region.
2. In 2014, Poliomyelitis (Polio Resurgence) Declared May 2014 and ended May 2023. It originated in Pakistan, Afghanistan, Nigeria.
3. In 2014, Ebola Virus Disease (West Africa) Declared Aug 2014 and ended Mar 2016. It originated in Guinea, Liberia, and Sierra Leone.
4. In 2016, Zika Virus, Declared Feb 2016 and ended Nov 2016. It originated in Brazil.
5. In 2018–2020, Ebola Virus Disease Declared Jul 2019 and ended Jun 2020. It originated in Democratic Republic of the Congo.
6. In 2020, COVID-19 (SARS-CoV-2), Declared Jan 2020 and ended May 2023. It originated in China.
7. In 2022, Monkeypox (now “Mpox”), Declared Jul 2022 and ended May 2023. It originated in Multiple countries.Why do these outbreaks raise such concerns?
There outbreaks raise such concerns because of
-Rapid international spread (e.g., H1N1, COVID-19, Mpox).
-Severe health impact and high fatality rates (e.g., Ebola).
-Weak health systems unable to contain transmission (e.g., West Africa Ebola outbreak).
-Potential for mutation or vaccine escape (e.g., Polio resurgence, Influenza).
-Social and economic disruption, including travel and trade restrictions.
-Uncertainty about the disease’s nature, transmission, or control (e.g., Zika’s link to microcephaly).In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
In my opinion, the following conditions are strong candidates that could trigger a PHEIC in the future:
a. Avian Influenza (H5N1, H5N6, H7N9 variants)
Sporadic human infections with very high case fatality (>50% in some strains).
Increasing reports of infection in mammals (e.g., sea lions, cats, cattle).
If sustained human-to-human transmission occurs, it could spark a global pandemic.
b. Antimicrobial Resistance (AMR)
While not an “outbreak” in the traditional sense, the rise of drug-resistant infections (e.g., carbapenem-resistant Klebsiella, resistant gonorrhea, XDR-TB) could cause uncontrollable international health crises.
It fits the criteria of a PHEIC due to its global spread, lack of treatment options, and impact on healthcare systems. -
A Public Health Emergency of International Concern (PHEIC) have been declared for the following disease outbreaks:
1. Influenza A (H1N1)
Date of Declaration: April 25, 2009
Date of Undeclaration: August 10, 2010
Rationale:
• The widespread presence of the virus
• Virus containment unfeasibility at that stage2. Poliomyelitis
Date of Declaration: May 5, 2014
Date of Undeclaration: Still remains as a PHEIC
Rationale:
• The risk of international spread of wild virus and the increasing evidence that adult travelers were contributing to the spread
• During the low season in 2014, there were 10 countries that are considered to have active transmission of wild poliovirus, and in contrast with previous years, there has already been a spread from three of these countries internationally
• Considering the large number of polio-free but conflict torn and fragile states which have severely compromised routine immunization services and are particularly at high risk of infection3. Ebola (West Africa)
Date of Declaration: April 25, 2009
Date of Undeclaration: August 10, 2010
Rationale:
• The Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States.
• The possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns and the weak health systems in the currently affected and most at-risk countries.
• A coordinated international response is deemed essential to stop and reverse the international spread of Ebola.4. Zika
Date of Declaration: February 1, 2016
Date of Undeclaration: November 18, 2016
Rationale:
• The rising international concerns about Zika infections in South America, especially in Brazil.
• The postulated link to rising numbers of babies born with the congenital abnormality known as microcephaly.5. Ebola (Democratic Republic of Congo)
Date of Declaration: July 17, 2019
Date of Undeclaration: June 26, 2020
Rationale:
• The concern about potential spread from Goma (as the city is a provincial capital with an airport with international flights.)
• The concern of the reinfection and ongoing transmission in Beni, which has been previously associated with seeding of virus into multiple other locations.
• The murder of two healthcare workers demonstrates continued risk for responders owing to the security situation.
• The lack of the global community contribution to sustainable and adequate technical assistance, human or financial resources for outbreak response, despite the previous recommendations for increased resources.6. COVID-19
Date of Declaration: January 30, 2020
Date of Undeclaration: May 5, 2023
Rationale:
• Significant increases in numbers of cases and additional countries reporting confirmed cases and that there are still many unknowns, and human-to-human transmission has occurred outside Wuhan and outside China.
• WHO believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk.7. Monkeypox
Date of Declaration: July 2022; August 14, 2024
Date of Undeclaration: May 2023; September 5, 2025
Rationale:
• The disease spread rapidly via sexual contact across a range of countries where the virus had not been seen before
• The emergence of a new clade of monkeypox, its rapid spread in eastern Democratic Republic of Congo (DRC), and the reporting of cases in several neighboring countries are very worrying.
• A coordinated international response is needed to stop outbreaks and save lives.References:
WHO Director-General declares mpox outbreak a public health emergency of international concern. (2024, August 14). World Health Organization (WHO). Retrieved October 28, 2025, from https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concernWilder-Smith, A., & Osman, S. (2020). Public health emergencies of international concern: a historic overview. Journal of travel medicine, 27(8), taaa227. https://doi.org/10.1093/jtm/taaa227
In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
In my opinion, measles is one disease that may potentially lead to PHEIC in the future. In the United States for example, measles has been officially eliminated since 2020 (meaning no measles spreading within the country and new cases are only found when someone contracts measles abroad and returns to the country). However, according to the CDC, a total of 1,618 confirmed measles cases have been reported as of October 21, 2025. There have been 43 outbreaks, and 87% of the confirmed cases (1,401 of 1,618) are outbreak-associated. Two fatalities due to measles have also been reported, the first time since 2015.
According to the WHO, least 95% of people in a community should be vaccinated in order to be protected through community immunity (herd immunity). In the US, however, vaccine coverage among US kindergartners has decreased from 95.2% during the 2019-2020 school year to 92.7% during the 2023-2024 school year. Vaccine hesitancy, fueled by misinformation and fake news, especially on social media, contributes to the continued decline in vaccine coverage.
Reference:
Measles cases and outbreaks. (2025, October 22). Measles (Rubeola). https://www.cdc.gov/measles/data-research/index.html -
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Could you list the disease outbreaks that have been declared as the Public Health Emergency of International Concern (PHEIC)?
The disease outbreaks that have been declared as the Public Health Emergency of International Concern are:
– 2009 H1N1 Pandemic,
– 2014 Polio,
– 2014 Ebola outbreak,
– 2015-2016 Zika Virus,
– 2018-2019 Kivu Ebola epidemic, and
– 2019 COVID-19 pandemicWhy do these outbreaks raise such concerns?
These outbreaks had a serious impact on public health, were unusual or unexpected, significant risk for international spread, and risk for trade or travel restrictions.
In your opinion, is there a disease or condition that may potentially lead to PHEIC in the future? Why?
A disease that may potentially lead to PHEIC in the future is Avian Influenza, which the WHO claimed that “There will be pandemics in the future, but when, where, and how they spread is difficult to predict. They can have significant health, economic, and social consequences. An influenza pandemic will occur when an influenza virus emerges with the ability to cause sustained human-to-human transmission, and the human population has little to no immunity against the virus. With the growth of global travel, a pandemic can spread rapidly.” That outbreak will meet at least 3 criteria for a potential PHEIC.
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