WHO Declares Monkeypox a Public Health Emergency 

It’s been two months since the first monkeypox cases were reported in individuals who had not traveled to countries where the disease is endemic. From the six cases reported in May within the United Kingdom, the outbreak has grown to more than 16,000 cases in 75 countries, with infections on every continent except Antarctica. Nearly 3,000 cases have been reported in the U.S. alone.

The World Health Organization (WHO) had not declared the outbreak a public health emergency until July 23rd. WHO Director-General, Tedros Adhanom Ghebreyesus, declared monkeypox to be a “public health emergency of international concern [PHEIC],” even though his advisory council did not unanimously recommend it.

Mr. Ghebreyseus stated, “We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations…For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern.”

So what does this mean in practical terms, and where do we stand in the outbreak? We’ve answered the following questions to provide some clarity. 

‍What does making monkeypox a PHEIC mean?

The declaration that monkeypox is now a PHEIC enables the WHO to take additional actions to address the outbreak. This includes providing global recommendations on how to minimize the spread, how to prevent infection, and how to treat the disease. The declaration also means the WHO can take a more active role in calling for a unified global response and pushing for equity regarding vaccine and treatment distributions.

‍Why didn’t most advisory board members think this declaration should be made?

The committee members who thought it was unnecessary to make this declaration had multiple concerns. One of the most prominent was a worry that the new designation could lead to stigmatization and harassment of men who have sex with men. Four of the six original cases reported in the United Kingdom were in men who have sex with men. The majority of cases worldwide are in this population as well. 

“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, leader of WHO’s Health Emergencies Program. “It’s very important that we get this balance right.”

The Director-General further emphasized the need to “adopt measures that protect the health, human rights and dignity of affected communities,” adding that “Stigma and discrimination can be as dangerous as any virus.”

‍How has the U.S. responded?

While the U.S. has increased its production of the monkeypox vaccine, some public health organizations do not think that’s enough. The Biden administration has not declared the monkeypox outbreak a public health emergency. On July 23rd, the National Coalition of STD Directors called for the President to declare the outbreak as a public health emergency and set aside $100 million in emergency funding. 

Additionally, on July 21st, the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) issued a statement recognizing the CDC’s “swift action in responding to health care provider concerns regarding the significant procedural barriers required to obtain tecovirimat, an antiviral medication, through the Expanded Access for Investigational New Drug program.” The previous process involved “significant obstacles and delays in treating severely ill patients with the monkeypox virus,” including burdensome paperwork. 

“However, more work remains to streamline and expand access to treatment and to collect data to further inform tecovirimat use,” the IDSA and HIVMA said. “Reducing barriers to treatment is also important to make it easier for private and community-based clinicians to treat patients with monkeypox, as well as help address equity and expand provider capacity.

‍What recommendations has the WHO made?

The WHO issued recommendations in four categories of countries based on the epidemiology of cases and the resources of those countries. The country categories include:

• Countries with no monkeypox cases in the last three weeks
• Countries with ongoing transmission of monkeypox where monkeypox is not endemic
• Countries where monkeypox is endemic
• Countries with the resources for manufacturing therapeutics, vaccines, and other pharmaceutical interventions

The recommendations made primarily focus on:

• Preparation
• Mobilization
• Implementation of measures to reduce the spread of the virus
• Assurance of adequate treatment for those who have the virus
• Reduction of stigmatization and discrimination
• Risk of missed treatment among those who have the disease and among populations at risk for it

You can read the details of all the recommendations in the WHO report here.