Geneva: A group of international clinicians and scientists has urged the World Health Organization (WHO) to overhaul its infection prevention and control guidance, warning that surgical face masks offer inadequate protection against flu-like illnesses, including COVID-19.
They argue that respirator-level masks should become mandatory for doctors and nurses during all face-to-face interactions with patients in healthcare settings.
In a letter addressed to WHO Director-General Dr. Tedros Adhanom Ghebreyesus, the experts said that there is ‘no rational justification remaining’ for the continued prioritisation or use of surgical face masks, which are widely used in hospitals and clinics around the world, given their limited effectiveness against airborne pathogens. They added that allowing healthcare workers to wear no face covering at all is even less defensible.
At the height of the COVID-19 pandemic, an estimated 129 billion disposable face masks were used globally every month by both healthcare workers and the public, with surgical face masks being the most widely available and recommended by most health authorities.
However, the authors noted that respirators designed to filter fine airborne particles, such as FFP2 and FFP3 masks in the UK or N95 masks in the United States, provide significantly higher levels of protection and should replace surgical masks as standard practice during medical interactions.
As additional scientific evidence emerged during the pandemic, health officials in several countries updated their guidance to recommend respirator masks as more effective. The authors contend that adopting respirators routinely in healthcare environments would lead to fewer infections among patients and health professionals, while also reducing sickness rates, staff absences, and burnout across the health workforce.
One of the letter’s organisers, Prof Adam Finkel of the University of Michigan School of Public Health, remarked that surgical face masks were never designed to block airborne pathogens but were instead intended to prevent doctors and nurses from contaminating surgical sites.
The Professor described surgical face masks as obsolete, comparing them to a typewriter in the era of modern computers. Finkel previously served as chief regulatory official at the US Occupational Safety and Health Administration between 1995 and 2000.
The letter emerged from discussions at an online conference held last year called Unpolitics, which focused on the implementation of evidence-based public policy. It was authored by seven clinicians and scientists, including Finkel, and has been endorsed by nearly 50 senior clinicians and researchers, as well as more than 2,000 members of the public, including clinically vulnerable patients.
The authors acknowledged that there could be ‘off-ramps’ allowing governments or institutions to decide that respirators are not necessary in certain situations, depending on factors such as community infection levels, ventilation quality, and the presence of air filtration systems in a room.
While the proposed guidance would apply only to healthcare settings, where infection risks are higher, the issue is expected to generate controversy, as face masks became a polarising cultural and political issue during the COVID-19 pandemic.
In December, UK Conservative Party leader Kemi Badenoch stated that she had been ‘slightly traumatised’ by the widespread mask-wearing during COVID, responding to remarks by an NHS leader who stated that the people with flu symptoms ‘must wear’ a face mask in public.
Although the WHO cannot impose a global policy, the signatories argue that updating its infection prevention and control guidelines to recommend respirators could have a profound global impact. They also propose that the WHO’s procurement systems could help expand access to respirators in lower-income countries, while gradually reducing the production and use of surgical face masks over time.
Finkel acknowledged that surgical masks are still better than no protection at all, noting that studies suggest they block around 40 percent of Covid-sized airborne particles. In comparison, respirators block roughly 80 percent of such particles and, in some cases, as much as 98 percent.
The Professor likened the difference in protection to falling from a height of four inches rather than four feet, saying the risk of injury remains but is substantially reduced. Critics of the group’s position point to a lack of randomised controlled trials demonstrating that physical measures such as masks slow the spread of respiratory viruses.
However, Finkel and his co-authors argue that such trials are inherently flawed, as participants cannot realistically wear masks continuously and may be exposed to pathogens while unmasked. Instead, they say laboratory-based physical tests showing respirators’ ability to block airborne particles provide sufficient evidence.
The letter also calls on the WHO to revisit earlier statements about COVID-19 transmission and to clearly and unambiguously inform the public that the virus spreads through airborne respiratory particles. The organisation has previously been criticised for being slow to acknowledge airborne transmission.
Prof Trisha Greenhalgh of the University of Oxford, whose research is extensively cited in the letter and who is among its signatories, emphasized that respirators offer superior protection because they seal tightly against the face, forcing airflow through high-grade filters that remove airborne germs. In contrast, Greenhalgh said, surgical face masks fit loosely and allow significant leakage.
In response, a WHO spokesperson noted that the organisation would undertake a careful review of the letter. The spokesperson added that the WHO consults widely with experts from diverse health, economic, and geographic contexts when developing guidance on personal protective equipment.
They confirmed that WHO is currently reviewing its Infection Prevention and Control guidelines for epidemic- and pandemic-prone acute respiratory infections, based on the latest scientific evidence, to ensure adequate protection for health workers.
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