Head of UN health agency declares monkeypox a global emergency

LONDON

The head of the World Health Organization said the growing outbreak of monkeypox in more than 70 countries is an “extraordinary” situation that has now been labeled a global emergency, a statement on Saturday that could spur new investment in the treatment of the once rare disease and aggravate the rush. for rare vaccines.

WHO Director-General Tedros Adhanom Ghebreyesus took the decision to release the statement despite a lack of consensus among experts on the UN health agency’s emergency committee. It was the first time the head of the UN health agency had taken such a step.

“We have an epidemic that has spread rapidly around the world through new modes of transmission that we understand too little and that meet the criteria of international health regulations,” Tedros said.

“I know it has not been an easy or straightforward process and that there are differing opinions among the members” of the committee, he added.

A global emergency is WHO’s highest level of alert, but the designation does not necessarily mean that a disease is particularly communicable or deadly. WHO emergency chief Dr Michael Ryan said the director-general made the decision to put monkeypox in this category to support the global community taking the current outbreaks seriously.

Although monkeypox has been established in parts of West and Central Africa for decades, it was not known to trigger large epidemics beyond the continent or to spread widely among people until in May, when authorities detected dozens of outbreaks in Europe, North America and elsewhere.

Declaring a global emergency means the monkeypox outbreak is an “extraordinary event” that could spread to more countries and requires a coordinated global response. The WHO has previously declared emergencies for public health crises such as the COVID-19 pandemic, the Ebola outbreak in West Africa in 2014, the Zika virus in Latin America in 2016 and ongoing efforts to eradicate poliomyelitis.

The emergency declaration primarily serves as advocacy to bring more global resources and attention to an outbreak. Past announcements have had a mixed impact, given that the UN health agency is largely powerless to get countries to act.

Last month, the WHO’s expert committee declared the global outbreak of monkeypox not yet an international emergency, but the group met this week to reassess the situation.

According to the US Centers for Disease Control and Prevention, more than 16,000 cases of monkeypox have been reported in 74 countries since around May. To date, deaths from monkeypox have only been reported in Africa, where a more dangerous version of the virus is spreading, primarily in Nigeria and Congo.

In Africa, monkeypox is mainly spread to people from infected wild animals like rodents, in limited outbreaks that have not usually crossed borders. In Europe, North America and elsewhere, however, monkeypox is spreading among people unrelated to animals or who have recently traveled to Africa.

The WHO’s leading expert on monkeypox, Dr Rosamund Lewis, said this week that 99% of all monkeypox cases beyond Africa are in men and that of those, 98% involved men who have sex with men. Experts suspect monkeypox outbreaks in Europe and North America spread sexually at two raves in Belgium and Spain.

“While I am declaring a public health emergency of international concern at this time, this is an outbreak that is concentrated among men who have sex with men, particularly those who have multiple sex partners,” he said. Tedros said. “It means this is an epidemic that can be stopped with the right strategies in the right groups.

Emergency Manager Ryan explained what preceded the chief executive’s decision:

“(Tedros) found that the committee did not come to a consensus, despite a very open, very helpful and thoughtful discussion of the issues, and that since he does not oppose the committee, what he acknowledges is that there are deep complexities in this issue,” Ryan said. “There are uncertainties on all sides. And he reflects that uncertainty and his determination that the event” be an emergency. world.

Ahead of Saturday’s announcement, Michael Head, senior researcher in global health at the University of Southampton, said it was surprising that the WHO had not already declared monkeypox a global emergency, explaining that the conditions were probably met weeks ago.

Some experts have questioned whether such a statement would help, arguing that the disease is not serious enough to warrant attention and that wealthy countries fighting monkeypox already have the funds to do so; most people recover without needing medical attention, although the lesions can be painful.

“I think it would be better to be proactive and overreact to the problem than to wait to react when it’s too late,” Head said. He added that the WHO’s emergency declaration could help donors like the World Bank make funds available to stop outbreaks both in the West and in Africa, where animals are the likely natural reservoir of monkeypox. .

In the United States, some experts have speculated that monkeypox may be on the verge of becoming an entrenched sexually transmitted disease in the country, like gonorrhea, herpes and HIV.

“The bottom line is that we have seen a change in the epidemiology of monkeypox where there is now widespread and unexpected transmission,” said Dr. Albert Ko, professor of public health and epidemiology at Yale University. . “There are genetic mutations in the virus that suggest why this may be happening, but we need a globally coordinated response to bring it under control,” he said.

Ko called for an immediate and rapid scaling up of testing, saying that, as in the early days of COVID-19, there were significant gaps in surveillance.

“The cases we are seeing are just the tip of the iceberg,” he said. “The window has probably closed for us to quickly stop epidemics in Europe and the United States, but it is not too late to prevent monkeypox from causing enormous damage to poorer countries without the resources to deal.”

In the United States, some experts have speculated that monkeypox could take hold there as the newest sexually transmitted disease, with officials estimating that 1.5 million men are at high risk of being infected. infected.

Dr Placide Mbala, a virologist who heads the global health department at Congo’s National Institute for Biomedical Research, said he hoped all global efforts to stop monkeypox would be equitable. Although countries like Britain, Canada, Germany and the United States have ordered millions of vaccine doses, none have gone to Africa.

“The solution must be global,” Mbala said, adding that any vaccine sent to Africa would be used to target those most at risk, such as hunters in rural areas.

“Vaccination in the West might help stop the outbreak there, but there will still be cases in Africa,” he said. “Unless the problem is resolved here, the risk to the rest of the world will remain.”