WHO has decided to classify monkeypox as a public health emergency of international concern, the highest alert level available to WHO. What does that mean and what's next?
A mutation of the monkeypox virus
((Depending on the decision, text passages marked in bold or # must be adapted.))
The World Health Organization (WHO) Emergency Committee met in Geneva on Thursday to discuss whether to declare a public health emergency of international concern (GNIT) due to the worldwide spread of monkeypox.
On May 20th this year, the UK registered 20 cases of monkeypox. Mainly homosexual men were affected. Since then, the number of infected people has risen sharply. On July 20, the WHO recorded nearly 14,000 cases, while the CDC recorded a jump from 14,511 to 15,378 in one day alone, from July 19 to July 20. The majority of cases in this current outbreak are registered in Europe.
Since July 14, Thailand, Serbia, Georgia, India and Saudi Arabia have also reported their first cases. The number of countries where monkeypox has been detected has increased to 72. As case numbers continue to rise, epidemiologists are divided over whether the WHO's decision, n/ato declare a public health emergency was right or wrong. The emergency committee met for the second time on Thursday. The first meeting took place on June 23rd. At the time, the Emergency Committee concluded that the outbreak had not yet reached the required threshold.
“It's a delicate decision for the committee to make,” said Jimmy Whitworth, professor of international health policy at the London School of Hygiene & Tropical medicine. “It is an unprecedented outbreak that is affecting many countries and would benefit from increased international coordination. On the other hand, it is an infection that we have the tools to control, most cases are mild The course and mortality rate is extremely low.”
What is GNIT?
The classification as a public health emergency of international concern is the highest alert level that WHO has in place. It is based on international health regulations agreed in 2005, which set out the rights and obligations of individual countries when dealing with cross-border health events.
The WHO defines a public health emergency of international concern as an “extraordinary event which, because of its international spread, is classified as a risk to the public health of other countries and may require coordinated international action”. The WHO further explains that this definition refers to serious, sudden, unusual or unexpected situations that have public health implications beyond national borders and may require immediate international intervention.
Who decides on the declaration of an emergency?
The WHO Emergency Committee makes a recommendation to WHO Director-General Tedros Adhanom Ghebreyesus. He then makes a final decision based on that recommendation. The Monkeypox Emergency Committee has 16 members. It will be chaired by former WHO Director of Immunization and Vaccination, Congolese Jean-Marie Okwo-Bele. The other committee members include epidemiologists and public health experts from around the world.
Pros and cons of declaring an emergency
Declaring a public health emergency of international scope is intended to support the mobilization and coordination of information and resources at both national and international levels to strengthen prevention and response.
In practice, however, the declaration of such an emergency can also mean a financial burden for affected countries, especially if travel and trade are restricted as a result. This is precisely why some states are reluctant to share public health data in the event of an outbreak. Critics of the system point out that an emergency is only declared when an outbreak is already about to spread internationally, i.e. has already reached an acute stage. That's why some critics are calling for multiple intermediate alert levels.
Watch video 05:00
COVID-19 and monkeypox: similar yet different
In the case of COVID-19, for example, a public health emergency was only declared at the end of January 2020. At the previous two meetings in the same month – several weeks after China had already taken containment measures – the decision had been taken against such action. According to studies, too many countries initially adopt a wait-and-see attitude, ignoring explanations until it is too late. Just like with COVID-19.
“People weren't listening,” lamented Michael Ryan, WHO's director of emergencies, on the second anniversary of the day COVID-19 was declared a pandemic. “We rang the alarm bells and people did nothing.” The strong political pressure to which such declarations are subject, as well as the often opaque or contradictory justifications of the emergency committees, are often criticized.
When have health emergencies been declared so far?
To date, the WHO has declared a health emergency of international scope six times, each time for viral diseases:
- In January 2020 because of COVID-19. The emergency was declared when the virus was first detected outside of China. The situation evolved into an ongoing global epidemic.
- In July 2019, due to an Ebola outbreak in eastern DRC.
- In February 2016, due to the Zika virus, which started in Brazil took and mainly affected Latin American countries.
- In August 2014, due to an Ebola outbreak in West Africa, which also spread to Europe and the US.
- In May 2014, due to polio, following an increase in cases of wild and vaccine-derived poliovirus in Afghanistan, Pakistan and Nigeria. Besides COVID-19, this is the only emergency still in force.
- 2009 because of H1N1 or the “swine flu” that spread from Mexico to the whole world.
< p>Three other outbreaks have been considered but rejected as emergency declarations, including a deadly MERS outbreak first identified in Saudi Arabia in 2013.
What next?
Regardless of the decision now made, “WHO will continue to do everything in its power to help countries stop transmission and save lives,” Tedros said at a press conference in Geneva on Wednesday.
Effective monkeypox vaccines already exist
Testing and vaccination are among the most effective weapons in the fight against monkeypox, but information is key, Tedros stresses. Most importantly, health officials work constructively with vulnerable groups, say experts. At Wednesday's press conference, Rosamund Lewis, WHO smallpox expert, pointed out that 98 percent of cases “affect men who have sex with men – particularly those who have recently had multiple anonymous or new partners”.
Due to the recent spike in the number of cases, some experts are warning of a potential pandemic. Jimmy Whitworth, on the other hand, says, “From what we know, we don't expect it to become widespread in the general population, so I don't think it will become a general epidemic.”
< p>Adapted from English by Phoenix Hanzo.