The World Health Organization has classified the global outbreak of monkeypox as a “public health emergency of international concern”, putting it on par with diseases such as Covid-19, Ebola and polio.
It is the highest possible designation under international health regulations and was last deployed for Covid-19 more than two years ago. The WHO does not have the authority to declare pandemics, although it began using the term for Covid in early 2020.
Announcing the decision on Saturday, WHO Director-General Tedros Adhanom Ghebreyesus said: “We have an outbreak that has spread around the world rapidly, through new modes of transmission about which we understand too little.”
Tedros said a WHO panel had been unable to reach a decision but had nevertheless decided to make the declaration, acting as a tie-breaker, given international health regulations.
The overall global risk of smallpox remained low, apart from Europe, where it was “high”, he said.
While the move has little significant practical effect other than sounding the alarm, it paves the way for more funding and stronger international collaboration on monkeypox research, which some experts have said is not there has been
The disease, which is endemic to sub-Saharan Africa and was first identified decades ago, has recently been detected on every inhabited continent.
More than 16,000 cases of confirmed smallpox have been reported so far, according to the Geneva health agency, mostly among men who have sex with men. At least five deaths have been reported in African nations, the WHO said.
Health authorities have warned that there is a risk of the disease spreading to more vulnerable groups if left unchecked.
The WHO’s technical lead for monkeypox, Rosamund Lewis, stressed that it was still possible to contain it because it appears to be concentrated in one demographic group.
Effective countermeasures are also available, including a vaccine, typically used against smallpox, and an antiviral.
Governments have struggled to ensure the supply of both, and in some places, such as the United Kingdom, New York City and parts of Canada, health authorities have expanded eligibility for vaccination to reach potentially vulnerable people. Some European countries are considering doing the same, officials said.
Preliminary evidence suggests the virus is mutating faster than expected, according to a Nature Medicine study published last month.
People with knowledge of the WHO discussions said there had been conflicting assessments of whether monkeypox should be classified as a Public Health Emergency of International Interest (PHEIC) when the task force evaluation met for the first time in June.
“There are those who want to avoid drama, who want to increase attention, who want to avoid criticism of the WHO for being too slow and who believe that nothing would change in the response,” one person said.
“African governments are saying, ‘We’ve had monkeypox for decades and you’re only now realizing it, and that’s because the richer countries in the north have some cases and you’re making all this noise.’
Another person familiar with the discussions said the hesitation was due to fears the health body would be accused of “going over the top”.
The WHO said at the time that a consensus had been reached and listed a number of circumstances that would trigger a review of the decision.
In 2020, the WHO faced accusations that it was slow to declare Covid a PHEIC, with critics saying the process had been deeply politicized.
Josie Golding, Head of Epidemiology and Epidemiology at the Wellcome Trust, said the world was facing a “double challenge … an endemic disease in Africa that has been neglected for decades, and a new outbreak affecting communities marginalized”.
“Governments need to take this more seriously and work together internationally to control this outbreak,” he said.