The World Health Organization (WHO) has declared the current monkeypox epidemic a global health emergency.
The committee of independent advisers, which met on Thursday 21 July 2022, was split on its decision on whether to call the growing monkeypox outbreak a Public Health Emergency of International Concern (PHEIC), the highest level high alert
WHO chief Dr. Tedros Adhanom Ghebreyesus broke the deadlock and declared the outbreak PHEIC. This is the first time that the WHO director-general has sidelined his advisers to declare a public health emergency.
The first case of monkeypox was reported in a child in the Democratic Republic of the Congo (then Zaire) in 1970. Since then, outbreaks have generally been small and traceable to a person recently returned from a country where the virus is endemic, which means countries in central and western Africa. But the current epidemic is unlike any previous one outside of Africa, in that there is sustained person-to-person transmission of the infection.
As of July 22, there have been 16,593 confirmed infections in 68 countries that have historically not reported monkeypox. Most infections have been reported from Europe. The vast majority of infections have been in men who have sex with men, especially men who have sex with multiple partners.
Models presented to the WHO suggest that the average number of people infected by a single infected person (the so-called R naught, remember that from the early days of the COVID pandemic?) is between 1.4 and 1.8 in men who have sex with men, but less than 1.0 in other populations. Thus, although occasional infections may spread to populations other than men who have sex with men, significant further spread is unlikely.
In Europe, the rate of increase in new smallpox cases each week has slowed in recent weeks. The vast majority of infections still occur in men who have sex with men.
In the UK, 97% of cases are in men who have sex with men, but the rate of growth of the epidemic appears to have dropped to zero or even turned negative in recent weeks. But it is plausible that the apparent drop in new infections is the gap between consecutive waves.
Recently, experts have been debating whether monkeypox is now a sexually transmitted disease. While monkeypox is certainly spread during sex, labeling it an STD would be counterproductive, as the infection could be spread through any intimate contact, even with condoms or without penetrative sex.
Accumulated confirmed cases of smallpox in the current outbreak. Our world in data, CC BY
For and against declaring a global health emergency
Broadly speaking, the WHO emergency committee’s arguments in favor of declaring a global health emergency include that monkeypox meets the requirement for a PHEIC under the WHO’s International Health Regulations: “an extraordinary event , which constitutes a public health risk to other states through international transmission, and which potentially requires a coordinated international response”.
Added to this are concerns that in some countries there is likely to be substantial under-reporting of the number of cases, occasional reports of infections in children and pregnant women, concerns that infections may become endemic in human populations or re-introduce yourself to risk. groups even after the current monkeypox pandemic is over.
Arguments against declaring it a global health emergency include the fact that the vast majority of infections are currently being seen in just 12 countries in Europe and North America, and there is evidence that cases are stabilising. or even decrease in these countries.
Almost all cases are in men who have sex with men and who have multiple partners, offering opportunities to stop transmission with interventions targeting this group. Another argument is that the severity of the disease on the outside seems low.
Although the emergency committee could not reach a consensus, Tedros made the decision to declare a PHEIC.
This declaration of a global health emergency will probably not lead to much change in control activities in the worst-affected counties outside of Africa. However, it may spur those countries that have seen few cases so far to ensure that their health systems can better manage if the infection spreads in their countries. Hopefully, it can also stimulate funding for research and improving the capacity of endemic countries to manage the disease.