Key Messages
• Public health and social measures (PHSM) have proven critical to limiting transmission of COVID-19 and reducing
deaths.
• The decision to introduce, adapt or lift PHSM should be based primarily on a situational assessment of the intensity of
transmission and the capacity of the health system to respond, but must also be considered in light of the effects these
measures may have on the general welfare of society and individuals.
• Indicators and suggested thresholds are provided to gauge both the intensity of transmission and the capacity of the
health system to respond; taken together, these provide a basis for guiding the adjustment of PHSM. Measures are
indicative and need to be tailored to local contexts.
• PHSM must be continuously adjusted to the intensity of transmission and capacity of the health system in a country and
at sub-national levels.
• When PHSM are adjusted, communities should be fully consulted and engaged before changes are made.
• In settings where robust PHSMs are otherwise in place to control the spread of SARS-CoV-2, allowing the relaxation
of some measures for individuals with natural or vaccine-induced immunity may contribute to limiting the economic
and social hardship of control measures. Applying such individualized public health measures must take into account a
number of ethical and technical considerations.
Introduction
Public health and social measures (PHSMs) are being implemented across the globe to suppress SARS-CoV-2 transmission and
reduce mortality and morbidity from COVID-19.1 PHSMs include personal protective measures (e.g. physical distancing,
avoiding crowded settings, hand hygiene, respiratory etiquette, mask-wearing); environmental measures (e.g. cleaning,
disinfection, ventilation); surveillance and response measures (e.g. testing, genetic sequencing, contact tracing, isolation, and
quarantine); physical distancing measures (e.g. regulating the number and flow of people attendinggatherings, maintaining
distance in public or workplaces, domestic movement restrictions); and international travel-related measures. In this context, it
does not include medical countermeasures such as drug administration or vaccination. PHSMs act in concert, and a combination
of measures is required to ensure adequate control. Measures should be implemented by the lowest administrative level for which
situational assessment is possible and tailored to local settings and conditions.
Several important developments have occurred since the publication of the previous Considerations for implementing and
adjusting public health and social measures in the context of COVID-19.
2 First, several COVID-19 vaccines have been approved
by national regulatory authorities and through WHO Emergency Use Listing (EUL).
3 Vaccination has begun in most countries,
bringing the prospect of significantly reducing severe disease and mortality further. Initial observational studies following rollout
of vaccines suggest that vaccines may lead to protection against infection and a reduction in transmission,4–6 which in addition
to PHSMs will help control the spread of the virus. Second, four WHO-classified variants of concern (VOCs) have emerged
since December 2020,7,8 which are more transmissible and some of which may cause more severe disease9 and/or lead to a degree
of vaccine escape, requiring potential adjustments to response measures to account for their different characteristics, including
their impact on vaccine effectiveness. Several other variants of interest (VOIs) are also being monitored. Finally, more evidence
is now available on the effectiveness of a range of individual and community-level measures (outlined in Table 3 below).
Control of SARS-CoV-2 will depend on: i) the prevalence of infection and of circulating variants; ii) the rate of growth or decline
in incidence; iii) the types, use of and adherence to control measures in place; iv) the speed with which vaccination occurs; v)
the targeting and uptake of the vaccines among high-risk groups; and vi) vaccine effectiveness and natural immunity in the
population.
10 National vaccination strategies should prioritize older individuals at highest risk of severe outcomes and health
workers, to rapidly reduce mortality and the burden of disease and protect health care services. However, with successful
COVID-19 vaccination of older populations following the prioritization of vulnerable groups, the virus may continue to spread
among unvaccinated younger population groups.After achieving high vaccination coverage of SAGE priority groups for stage
Considerations for implementing and adjusting public health and social measures in the context of COVID-19: Interim guidance
I and stage II (as outlined in the WHO SAGE Roadmap For Prioritizing Uses of COVID-19 Vaccines in the Context of Limited
Supply)12 across all countries, accelerating vaccination of other priority groups will be required to lower the infection rate,
especially in areas of high population density.
13
While vaccination is underway, PHSMs will need to continue to be implemented, in a tailored and agile way, particularly
considering uncertainty in vaccine performance against known and potentially emerging VOCs and limited sequencing capacity
to detect variants worldwide.
14 Moreover, significant inequities in global vaccine access mean that, globally, control of disease
will continue to rely on PHSM for the foreseeable future, modulated by different levels of vaccination. Implementation of stricter
PHSMs, however, needs to be balanced against their socio-economic impacts, especially in settings with high dependence on
daily wages and informal economy. Decisions to tighten, loosen, or introduce PHSMs to control COVID-19 must be weighed
against the positive and negative impacts these measures have on societies and individuals. Considerations include impacts on
health, economy, security, mental health, and psychosocial wellbeing, human rights, food security, socioeconomic disparities,
continuity of other public health programmes, treatment and management of medical conditions other than COVID-19 and
gender-based violence. Other important considerations include vaccine acceptance and uptake, confidence, trust, motivational
elements to get vaccinated and public sentiment and adherence to PHSMs. The overall health and wellbeing of communities
should therefore be at the forefront of considerations when deciding on and adjusting PHSMs.
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