Manas Dasgupta
NEW DELHI, July 23: After the Covid-19, the World Health Organization has now declared monkeypox a “global emergency” in view of the outbreak of the disease in more than 70 counties.
The WHO Director-General Tedros Adhanom Ghebreyesus said on Saturday that expanding monkeypox outbreak in more than 70 countries was an “extraordinary” situation that now qualifies as a “global emergency,” the WHO’s highest level of alert. The declaration could spur further investment in treating the once-rare disease and worsen the scramble for scarce vaccines.
Although monkeypox has been established in parts of central and west Africa for decades, it was not known to spark large outbreaks beyond the continent or to spread widely among people until May, when authorities detected dozens of epidemics in Europe, North America and elsewhere.
Declaring a global emergency means the monkeypox outbreak is an “extraordinary event” that could spill over into more countries and requires a coordinated global response. WHO previously declared emergencies for public health crises such as the COVID-19 pandemic, the 2014 West African Ebola outbreak, the Zika virus in Latin America in 2016 and the ongoing effort to eradicate polio. The emergency declaration mostly serves as a plea to draw more global resources and attention to an outbreak. Past announcements had mixed impact, given that the U.N. health agency is largely powerless in getting countries to act.
The WHO label – a “public health emergency of international concern” – is designed to sound an alarm that a coordinated international response is needed and could unlock funding and global efforts to collaborate on sharing vaccines and treatments.
Members of an expert committee that met on Thursday to discuss the potential recommendation were split on the decision, two sources who spoke on the condition of anonymity told Reuters earlier, but the final decision falls to the U.N. agency’s director-general.
Announcing his decision to declare the health emergency during a media briefing in Geneva, Tedros confirmed that the committee had failed to reach a consensus, with nine members against and six in favour of the declaration.
Previously, Tedros has typically endorsed expert committee recommendations, but the sources said he had likely decided to back the highest alert level due to concerns about escalating case rates and a short supply of vaccines and treatments, despite the lack of a majority opinion.
So far this year, there have been more than 16,000 cases of monkeypox in more than 75 countries, and five deaths in Africa. To date, monkeypox deaths have only been reported in Africa where a more dangerous version of the virus is spreading, mainly in Nigeria and Congo. In India, so far three cases of monkeypox have been reported, all in Kerala.
The viral disease – which spreads via close contact and tends to cause flu-like symptoms and pus-filled skin lesions – has been spreading chiefly in men who have sex with men in the recent outbreak, outside Africa where it is endemic.
In Africa, monkeypox mainly spreads to people from infected wild animals like rodents, in limited outbreaks that typically have not crossed borders. In Europe, North America and elsewhere, however, monkeypox is spreading among people with no links to animals or recent travel to Africa.
WHO’s top monkeypox expert, Dr. Rosamund Lewis, said this week that 99% of all the monkeypox cases beyond Africa were in men and that of those, 98% involved men who have sex with men. Experts suspect the monkeypox outbreaks in Europe and North America were spread via sex at two raves in Belgium and Spain.
“The bottom line is we’ve seen a shift in the epidemiology of monkeypox where there’s now widespread, unexpected transmission,” said Dr. Albert Ko, a professor of public health and epidemiology at Yale University. “There are some genetic mutations in the virus that suggest why that may be happening, but we do need a globally-coordinated response to get it under control,” he said.
Dr. Ko called for testing to be immediately scaled up rapidly, saying that similar to the early days of COVID-19, that 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 the outbreaks in Europe and the U.S., but it’s not too late to stop monkeypox from causing huge damage to poorer countries without the resources to handle it.”
In the U.S., some experts have speculated that monkeypox might become entrenched there as the newest sexually transmitted disease, with officials estimating that 1.5 million men are at high risk of being infected. Dr. Placide Mbala, a virologist who directs the global health department at Congo’s Institute of National Biomedical Research, said he hoped any global efforts to stop monkeypox would be equitable. Although countries including Britain, Canada, Germany and the U.S. have ordered millions of vaccine doses, none have gone to Africa.
“The solution needs to be global,” Dr. Mbala said, adding that any vaccines sent to Africa would be used to target those at highest risk, like 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 solved here, the risk to the rest of the world will remain.”
The WHO and national governments have been facing intense pressure from scientists and public health experts to take more action on monkeypox. Cases of the viral disease have ballooned since the committee first met at the end of June, when there were only about 3,000 cases. At the time, the expert group agreed to reconsider their position on the emergency declaration if the outbreak escalated.
One of the key issues driving a re-assessment was whether cases that are almost entirely proliferating amongst men who have sex with men would bleed into other groups, particularly children or others who have been vulnerable to the virus in past outbreaks in endemic countries. On Friday, the United States identified its first two monkeypox cases in children.
Any changes to the virus itself could also spark a rethink, the committee had said.
There’s currently no specific treatment for monkeypox. Patients will usually need to stay in a specialist hospital so the infection doesn’t spread and general symptoms can be treated.