Open Letter to WHO: A Call for the Universal use of Respirators in Healthcare (7 January 2025)

Summary

This open letter to the World Health Organization (WHO), signed and endorsed by a group of global health experts, makes the case that surgical masks provide inadequate protection against airborne pathogens. It calls on the WHO to take a lead in establishing respirators as the universal default for all healthcare encounters. The letter includes a seven-step plan outlining how the WHO should implement this change.

Content

The signatories urge the WHO to act now to address the threat of airborne transmission, and take the following steps:

1. Update IPC Guidelines to recommend respirators (e.g., N95, FFP2/3, elastomeric) in all healthcare settings — not just during outbreaks or high-risk procedures, but as a baseline occupational safety standard. The Guidelines could recommend locally-determined off-ramps based on precautionary interpretations of current local and establishment-specific conditions.
2. Revisit prior statements about how SARS-CoV-2 is transmitted, and unambiguously inform the public that it spreads via airborne respiratory particles (a term subsuming both “aerosols” as well as “droplets”).  Restoring public trust begins with transparency and accountability.  To close the knowledge gap, provide comprehensive training and education on risk reduction for airborne hazards.
3. Leverage WHO’s partnerships and procurement infrastructure to support equitable access to certified respirators globally — particularly for healthcare systems in low- and middle-income countries. Over time, surgical masks should be produced in progressively smaller quantities, as safer, more effective respirators have been and remain readily available.
4. Launch global campaigns normalizing the use of respirators as a basic tool of infection prevention — not as emergency gear, but as modern personal protective equipment.
5. Integrate universal respiratory protection into pandemic preparedness frameworks, including the forthcoming WHO Pandemic Accord. Respirators must no longer be treated as optional, nor as luxury items.
6. Convene multidisciplinary experts, including industrial hygienists, aerosol scientists, social scientists, healthcare workers, disease transmission modelers, and patient advocates, as well as infectious disease modelers, to advise on implementation and adherence.
7. Clearly, publicly, and regularly reinforce the message that while WHO had stopped referring to SARS-CoV-2 as a Public Health Emergency of International Concern in 2023, the pandemic is still ongoing. This will make countries accountable for mitigating the ongoing risks or covering the ongoing costs of inaction.