date of the declaration, there were 17,186 cases reported globally, affecting 75 countries in all six WHO regions, with five deaths reported outside Africa and 72 deaths in African countries. Previously, the WHO had held an EC meeting on 23 June 2022 regarding the outbreak, which had more than 2,100 cases in over 42 countries at that point. It didn't reach the criteria for a PHEIC alert at the time. Response In 2018, an examination of the first four declarations (2009–2016) showed that the WHO was noted to be more effective in responding to international health emergencies, and that the international system in dealing with these emergencies was "robust". Another review of the first four declarations, with the exception of wild polio, demonstrated that responses were varied. Severe outbreaks, or those that threatened larger numbers of people, did not receive a swift PHEIC declaration, and the study hypothesized that responses were quicker when American citizens were infected and when the emergencies did not coincide with holidays. Non-declarations 2013 MERS PHEIC was not invoked with the Middle Eastern Respiratory Syndrome (MERS) outbreak in 2013. Originating in Saudi Arabia, MERS reached more than 24 countries and resulted in more than 580 deaths by 2015, although most cases were in hospital settings rather than sustained community spread. As a result, what constitutes a PHEIC has been unclear. As of May 2020, there had been 876 deaths. Non-infectious events PHEIC are not confined to only infectious diseases or biological ones. It may cover events caused by chemical agents or radioactive materials. Debate exists regarding whether the emergence and spread of antimicrobial resistance may constitute a PHEIC. See also Biosecurity Disease X Public health emergency (United States) State of emergency References Further reading Statement of the Twenty-Third IHR Emergency Committee Regarding the International Spread of Poliovirus. WHO, 7 January 2020 External links International Health Regulations and Emergency Committees. www.who.int Health law World Health Organization Emergency management