The monkeypox outbreak is not yet a global health emergency

By on June 26, 2022 0

JThe World Health Organization declined on Saturday to declare the unprecedented outbreak of monkeypox which has spread worldwide a public health emergency as of now.

A public health emergency of international concern, or PHEIC, grants the WHO director-general certain powers, such as the ability to recommend how countries should respond. While it’s a legal lever the agency can use, it’s also a tool that can get the public’s attention and focus in trying to address growing health threats. Such a statement could further rally donors and member countries to increase funding.

The WHO can reconsider its decision. In January 2020, for example, the WHO did not declare the emerging coronavirus crisis a USPPI, only to do so a week later.


The announcement came after a WHO emergency committee met on Thursday to discuss the home. Some 3,000 cases have been documented since mid-May, mostly in Europe and the Americas – apart from parts of West and Central Africa where the virus is endemic and has animal reservoirs. Most of the cases have been in gay, bisexual and other men who have sex with men, with many occurring in men who have had multiple recent sexual partners. One death has been reported, in an immunocompromised person.

Despite the USPPI’s decision, WHO Director-General Tedros Adhanom Ghebreyesus sought to emphasize the seriousness of the threat, noting that the convening of an emergency committee was a sign of it. In a statement, Tedros noted that the outbreak “is clearly an evolving health threat” that “requires our collective attention and coordinated action now.” But he said the committee that advised him on the matter decided the outbreak did not yet constitute a USPPI, and he agreed.


“What makes the current outbreak of particular concern is the rapid and continued spread to new countries and regions and the risk of further and sustained transmission to vulnerable populations, including immunocompromised people, pregnant women and children” , Tedros said in the statement. “Therefore, there is an urgent need for all Member States, communities and individuals to follow the committee’s recommendations for enhanced surveillance, better diagnostics community engagement and risk communication, and the appropriate use of treatments. , vaccines and public health measures, including contact tracing and isolation.

In a summary of the committee’s discussion, the WHO said the group recognized that the facets of the outbreak were unusual and that the response clearly required international efforts, but that “although a few members expressed divergent views” , the committee reached consensus that the outbreak did not constitute a USPPI. The committee said it should reconsider the decision depending on the acceleration of cases in the coming weeks; more countries are beginning to report cases; whether there are increases in cases in other groups of people, including sex workers; and if there are signs that the virus is becoming more transmissible or starting to cause more severe disease.

A PHEIC (pronounced as “fake”) describes an extraordinary or unusual health threat that poses risks to other locations through international spread and requires a coordinated response. USPPIs are usually declared when urgent international action is required.

A USPPI is not the same as a pandemic. The former is a technical mechanism that the WHO can use, while the latter is a rhetorical acknowledgment of the vast global spread of a disease. When the WHO started calling Covid-19 a pandemic, for example, it was a reflection of the scale of the crisis, not a move that gave the agency more power.

WHO has worked to ensure equitable distribution of vaccines and drugs that can prevent and treat monkeypox. These vaccines and treatments are in short supply and countries in Europe and the Americas have been trying to buy more.

In the past, monkeypox infections seen outside countries where the virus is endemic were usually imported cases or involved limited domestic transmission. This is the first time the virus has begun to circulate more widely in other countries.

Gregg Gonsalves, associate professor of epidemiology at the Yale School of Public Health, disagreed with the WHO’s decision, which he called a “punt”. He said he believed the criteria had been met and that a PHEIC declaration could have prompted public health authorities to step up their response and coordinate better between countries.

Gonsalves served as an adviser to the emergency committee, but had no say in whether to recommend the declaration of a USPPI.

“An expanding epidemic of this disease is not good for anyone,” he said, noting that African public health officials have been saying for years that monkeypox needs more global attention. “Right now, we’re not at the top of our game with monkeypox, at least in the United States,” he added, pointing to the patchy surveillance system and limited vaccine deployment.

Monkeypox infections can lead to painful lesions and rashes, including blisters forming on the palms. Some of the cases in the current outbreak have been mild and diverge from classic cases of infection, with people having only a few genital or anal sores instead of larger rashes. Many cases in the current outbreak have been relatively mild, although some patients have been hospitalized for pain management while the infection runs its course.

The virus is transmitted through close contact, primarily through respiratory droplets or direct exposure to lesions or contaminated clothing or linens.

Some countries have started vaccinating contacts of infected people, and some have recently expanded eligibility criteria, with health officials in the UK, parts of Canada and New York City Offer vaccines for larger groups of men who have sex with men.

Although the number of documented cases has recently increased, genetic analyzes suggest that the virus could have circulated in people at low levels for several years before taking off.

In the current outbreak, the United States has reported 200 cases of monkeypox, though public health experts are concerned that number does not reflect the true extent of the virus’ spread. Germany has identified over 675 cases, Portugal over 300 and the UK over 900.

South Africa Thursday also reported one case in a person who had no recent travel history.

In addition, the United States announced on Wednesday that it had started shipping monkeypox tests to five commercial lab companies to expand testing. The raw testing capacity of the country was not the key problembut clinicians and advocates had reported the process to get a test – which involved contacting local health departments and a two-step testing scheme – was too complicated and made it difficult for individuals to find clinics willing to provide tests.

The PHEIC designation was created in an update to the International Health Regulations following the 2002-2003 SARS outbreak. The regulations, which are agreed to by WHO member states, are designed to help the world respond to public health threats while avoiding “unnecessary interference with international traffic and trade”, according to the WHO.

The first PHEIC was declared for the 2009 H1N1 influenza pandemic, and others have included the Ebola outbreaks and the Zika outbreak. The two active PHEICs are for Covid-19 and ongoing polio transmission.