WHO declares monkeypox an international health emergency

The World Health Organisation has declared the recent outbreak of monkeypox in many countries a public health emergency of international concern.

This alert is the highest that the UN agency can trigger for countries to put in place the necessary protocols to try to contain a viral outbreak and prevent it from becoming a pandemic. The last time the WHO made such a decision was in January 2020 when it declared COVID-19 an international health emergency.

WHO director-general Dr Tedros Adhanom Gebreyesus convened the International Health Regulations Emergency Committee last month when there had been 3040 cases of monkeypox from 47 countries to assess whether the outbreak of monkeypox in several countries represented a public health emergency of international concern.

"At that meeting, although different views were expressed, the committee resolved by consensus that the outbreak did not represent a public health emergency of international concern. Since then, the outbreak has continued to grow, with more than 16,000 cases reported in 75 countries and territories, and five deaths," Tedros told a news conference in Geneva.

Faced with this increase, Tedros decided to reconvene the committee last Thursday, but this time the committee could not reach consensus on whether the outbreak represents a public health emergency of international concern, so the director general had to act as arbiter and make the final decision.

"According to the International Health Regulations, I have to consider five elements to decide whether an outbreak constitutes a public health emergency of international concern," Tedros explained:

• First, the information provided by countries, which in this case shows that this virus has spread rapidly to many countries that have not seen it before.
• Second, the three criteria for declaring a public health emergency of international concern under the International Health Regulations, which have been met.
• Third, the advice of the Emergency Committee, which has not reached consensus.
• Fourth, the scientific principles, evidence and other relevant information, which is currently insufficient and leaves us with many unknowns.
• Fifth, the risk to human health, international spread and the potential for interference with international traffic.

Dr Tedros added that, taking these elements into account, the WHO assessment is that the risk of monkeypox is moderate globally and in all regions except the European region, where the risk is assessed as high.

There is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the time being.

"In summary, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand very little, and which meets the criteria of the International Health Regulations," he added.

For all these reasons, I have decided that the global outbreak of monkeypox represents a public health emergency of international concern," he said.

The reasons the Committee members gave for and against it will be set out in a report to be published later by WHO.

The WHO official noted that while he was declaring an international public health emergency, "at the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners".

This means that it is an outbreak that can be stopped with the right strategies in the right groups.

It is therefore essential that all countries work closely with communities of men who have sex with men to design and deliver effective information and services, and to take measures to protect the health, human rights and dignity of affected communities.

"Stigma and discrimination can be as dangerous as any virus," said Tedros.

In addition to our recommendations to countries, I also call on civil society organizations, including those with experience working with people living with HIV, to work with us in the fight against stigma and discrimination.

The good news, Tedros said, is that in the case of monkeypox "transmission can be stopped and the outbreak can be controlled with the tools we have now".

Tedros said the follow-up has made a series of recommendations to four groups of countries, ranging from those that have not yet reported any monkeypox cases, or have not done so for more than 21 days; to those with recently imported monkeypox cases that are experiencing human-to-human transmission; to countries where transmission is often animal-to-human; and to countries that have the capacity to manufacture diagnostic tests, vaccines and therapies.

Among the recommendations, the WHO calls for:

• Implementing a coordinated response to stop transmission and protect vulnerable groups
• Engage and protect affected communities
• Intensify surveillance and public health measures
• Strengthen clinical management and infection prevention and control in hospitals and clinics
• Accelerate research on the use of vaccines, therapies and other tools.
• Recommendations on international travel