The World Health Organization on Saturday declared the monkeypox outbreak, which has affected more than 70 countries, an “emergency of international concern” as the WHO chief said it was an “extraordinary” situation that warranted the declaration of a global emergency. The announcement could spur new investment in treatment of the once rare disease and worsen the rush for rare vaccines.
WHO Director-General Tedros Adhanom Ghebreyesus decided to release the statement despite a lack of consensus among experts on the UN health agency’s emergency committee. It was the first time the head of the UN health agency took such a step.
“We have an epidemic that has spread rapidly around the world through new modes of transmission that we understand too little and that meet the criteria of international health regulations,” Tedros said.
“I know it has not been an easy or straightforward process and that there are differences of opinion among members,” he added.
A global emergency is WHO’s highest level of alert, but the designation does not necessarily mean that a disease is particularly communicable or fatal. WHO’s emergency manager, Dr. Michael Ryan, said the director-general made the decision to classify monkeypox in this category to make the global community take the current outbreaks seriously.
Although monkeypox has been established in parts of West and Central Africa for decades, it was not known to trigger large epidemics beyond the continent or to spread widely among humans until May, when authorities discovered dozens of outbreaks in Europe, North America and other places.
Declaring a global emergency means that the monkeypox outbreak is an “extraordinary event” that could spread to other countries and requires a coordinated global response. , the Zika virus in Latin America in 2016 and ongoing efforts to eradicate polio.
The emergency declaration serves primarily as an advocacy to bring more global resources and attention to an outbreak. Previous announcements have had a mixed effect, as the UN health agency is largely powerless to get countries to act.
Last month, WHO’s expert committee declared that the global outbreak of monkeypox was not yet an international emergency, but the group met this week to reassess the situation.
According to the US Centers for Disease Control and Prevention, more than 16,000 cases of monkeypox have been reported in 74 countries since around May. So far, deaths from monkeypox have only been reported in Africa, where a more dangerous version of the virus is spreading, primarily in Nigeria and the Congo.
In Africa, monkeypox is mainly spread to humans from infected wild animals such as rodents, in limited outbreaks that have not usually crossed borders. However, in Europe, North America and elsewhere, monkeypox is spreading among people who are not related to animals or who have recently traveled to Africa.
WHO’s leading expert on monkeypox, Dr. Rosamund Lewis, said this week that 99% of all monkeypox cases outside of Africa are in men, and that of those, 98% involved men who have sex with men. Experts suspect that monkeypox outbreaks in Europe and North America may have spread sexually at two raves in Belgium and Spain.
“Although I am declaring a public health emergency of international concern at this time, this is an epidemic that is concentrated among men who have sex with men, especially those who have multiple sexual partners,” Tedros said. “This means that this is an epidemic that can be stopped with the right strategies in the right groups.”
Emergency Manager Ryan explained what preceded the CEO’s decision:
“(Tedros) found that the committee did not reach agreement, despite a very open, very useful and very thoughtful discussion of the issues, and that since he is not against the committee, what he recognizes is that there are deep complexities in this problem,” Ryan said. “There are uncertainties on all sides. And it reflects that uncertainty and its determination that the event is a global emergency.
Ahead of Saturday’s announcement, Michael Head, senior research fellow in global health at the University of Southampton, said it was surprising the WHO had not already declared monkeypox a global emergency, explaining the conditions were likely met weeks ago.
Some experts have questioned whether such a statement would help, arguing that the disease is not serious enough to warrant attention and that rich countries fighting monkeypox already have the means to do so; most people recover without needing medical attention, although the lesions can be painful.
“I think it would be better to be proactive and overreact to the problem than wait to react when it’s too late,” Head said. He added that the WHO’s emergency declaration could help donors such as the World Bank provide funds to stop outbreaks both in the West and in Africa, where animals are likely to be the natural reservoir for monkeypox.
In the United States, some experts have speculated that monkeypox may be on the verge of becoming an established sexually transmitted disease in the country, like gonorrhea, herpes and HIV.
“The bottom line is that we have seen a change in the epidemiology of monkeypox, where there is now widespread and unexpected transmission,” said Dr. Albert Ko, professor of public health and epidemiology at Yale University. “There are genetic mutations in the virus that suggest why this might happen, but we need a globally coordinated response to bring it under control,” he said.
Ko called for an immediate and rapid scale-up of testing, saying that, as in the early days of COVID-19, there were significant gaps in surveillance.
“The cases we’re seeing are just the tip of the iceberg,” he said. “The window is probably closed for us to quickly stop epidemics in Europe and the United States, but it is not too late to prevent monkeypox from causing enormous damage to the poorest countries without the resources to deal with it.
In the United States, some experts have speculated that monkeypox could take hold there as the newest sexually transmitted disease, with officials estimating that 1.5 million men are at high risk of infection.
Dr. Placide Mbala, a virologist who heads the global health division at Congo’s National Institute for Biomedical Research, said he hoped any global effort to end monkeypox would be fair. Although countries such as the UK, Canada, Germany and the US have ordered millions of vaccine doses, none have gone to Africa.
“The solution must be global,” Mbala said, adding that any vaccine sent to Africa would be used to target the most vulnerable, such as rural hunters.
“Vaccination in the West may help stop the outbreak there, but there will still be cases in Africa,” he said. “Unless the problem is solved here, the risk to the rest of the world will remain. »