The World Health Organization on Saturday declared the unprecedented monkeypox outbreak that has spread around the world a public health emergency, a decision that will empower the agency to take additional measures to try to curb the virus’s spread.
In an unusual move, WHO Director-General Tedros Adhanom Ghebreyesus made the declaration even though a committee of experts he had convened to study the issue did not advise him to do so, having failed to reach a consensus. The same committee met just one month ago and declined to declare a public health emergency of international concern, or PHEIC.
Though the committee does not formally vote, a survey of the members revealed that nine thought a PHEIC should not be declared and six supported a declaration. When the group met in June, the breakdown was 11 against and three for.
“Nine and six is very, very close,” Tedros said in a news conference called to announce the decision. “Since the role of the committee is to advise, I then had to act as a tie-breaker.”
“We believe this will mobilize the world to act together. It needs coordination and not only coordination but solidarity,” he said.
In a report on the meeting issued Saturday, the WHO said the members of the emergency committee who did not think a PHEIC should be declared were concerned, among other things, that it might provoke mistreatment and stigmatization of men who have sex with men, the community in which the vast majority of the cases in this outbreak are occurring. The global health agency was firm in its insistence that this should not happen.
“It is exceptionally important that the existence of a public health emergency of international concern and the intensification of surveillance and control efforts are not used as a means of coercive surveillance or for imposition of measures that would impede the dignity and human rights of the people affected,” said Mike Ryan, who leads the WHO’s Health Emergencies Program. “It’s very important that we get this balance right.”
Monkeypox is endemic only in about a dozen countries in Central and Western Africa. But in May, public health officials in London reported six cases in people who had not traveled to endemic countries. Four of the six were in men who have sex with men.
The number of cases internationally has ballooned in the ensuing weeks, now reaching more than 16,000 in over 75 countries throughout Europe, North and South America, the Middle East, new parts of Africa, South Asia, and Australia. The United States has recorded nearly 2,900 cases.
The PHEIC (pronounced like “fake”) gives Tedros certain powers, such as the ability to recommend how countries should respond. It could also rally global coordination for a more unified response. Part of that effort may involve ensuring the more equitable distribution of vaccines and treatments, which are in short supply.
The WHO issued a lengthy list of recommendations on Saturday, broken down into four groups: recommendations for countries that have not yet detected a case of monkeypox; those for countries with ongoing human-to-human transmission; those for countries where the virus is endemic in nature; and those for countries with capacity to produce monkeypox vaccine and therapeutics. Countries with no cases, for instance, were urged to strengthen their surveillance and be prepared to deal with infections if they occur. Countries with production capacity for drugs and vaccines were urged to increase and share output.
Thus far, the outbreak has been concentrated largely among gay, bisexual, and other men who have sex with men, with many occurring in men who have had multiple recent sex partners — a fact that the WHO believes increases the chances the outbreak can be brought under control.
“This is an outbreak that can be stopped with the right strategies in the right groups,” Tedros said.
But health officials have stressed that the outbreak could spread to more vulnerable populations, including pregnant women, immunocompromised people, and children. And in fact on Thursday, Dutch researchers reported a case in a boy under the age of 10 who had no discernible link to any other infected individuals. Meanwhile, two children in the United States have been infected — likely through household transmission.
More broadly, some experts have expressed concern that it may be too late to try to contain the outbreak and that monkeypox may become endemic in countries worldwide.
In the United States, many of the cases have been diagnosed through sexual health clinics. On Saturday, the National Coalition of STD Directors urged the Biden administration to follow WHO’s lead and declare monkeypox a national public health emergency. The organization also called on the government to allocate $100 million in emergency funding.
“While the administration has taken steps to address the monkeypox outbreak including accelerating the distribution of vaccines and allocating critical funding for monkeypox research, it quite simply is not enough,” David C. Harvey, the group’s executive director, said in a statement.
“Cities and states around the country have been left to respond to this outbreak on their own, making impossible decisions about how and when to allocate vaccines, provide therapeutics that are needed to recover, and educate the public.”
The Department of Health and Human Services is in discussions over whether declaring an emergency would help in the response, Ashish Jha, the White House Covid-19 coordinator, said during a media briefing on the U.S. monkeypox response of Friday.
“I think with public health emergencies it’s always important to ask very specific questions about what exactly would that allow us to be able do differently than we’re doing now, and would that make it easier to be able to respond to this outbreak,” Jha said. “It’s an ongoing but a very active conversation at HHS.”
Monkeypox infections lead to painful lesions and rashes, including vesicles forming on the palms. While cases historically have featured broad rashes, cases in the current outbreak have predominantly involved people having just a few genital or anal lesions.
The monkeypox virus is spread through close contact, mainly through direct exposure to lesions, to contaminated clothing or linens, or through respiratory droplets. So far, no deaths from the virus have been reported in the United States or Europe, even as case counts have risen. The Central African Republic and Nigeria — two of the countries were monkeypox is endemic — have reported five deaths so far in 2022.
Josie Golding, head of epidemics and epidemiology at Britain’s Wellcome Trust, said this outbreak should be a wake-up call for world leaders to shore up the globe’s capacity to deal with infectious diseases outbreaks.
“With monkeypox cases continuing to rise and spread to more countries, we now face a dual challenge: an endemic disease in Africa that has been neglected for decades, and a novel outbreak affecting marginalized communities. Governments must take this more seriously and work together internationally to bring this outbreak under control,” Golding said in a statement. “We cannot afford to keep waiting for diseases to escalate before we intervene.”
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