Maria Cheng, The Associated Press Published Saturday, July 23, 2022, 10:44 a.m. EDT Last updated Saturday, July 23, 2022, 10:58 a.m. EDT
LONDON (AP) — The head of the World Health Organization said the expanding monkeypox outbreak in more than 70 countries is an “extraordinary” situation that now qualifies as a global emergency, a declaration Saturday that could spur further investment in treatment of the once-rare disease and worsens the struggle for scarce vaccines.
WHO Director-General Tedros Adhanom Ghebreyesus made the decision to issue the declaration despite a lack of consensus among experts working on the UN health agency’s Emergency Committee. It was the first time the head of the UN health agency had taken such action.
“We have an outbreak that has spread rapidly around the world through new modes of transmission that we understand very little about and that meet the criteria in international health regulations,” Tedros said.
“I know that this is not an easy or straightforward process and that there are differing opinions among committee members,” he added.
A global emergency is the WHO’s highest level of alert, but the designation does not necessarily mean that the disease is particularly transmissible or deadly. The WHO’s head of emergencies, Dr Michael Ryan, said the director-general made the decision to put monkeypox in this category to show that the global community was taking the current outbreaks seriously.
Although monkeypox has been established in parts of central and west Africa for decades, it was not known to cause large outbreaks outside the continent or spread widely among humans until May, when authorities discovered dozens of outbreaks in Europe, North America and elsewhere.
The declaration of a global emergency means that the monkeypox outbreak is an “extraordinary event” that could spread to more countries and requires a coordinated global response. WHO has previously declared emergencies for public health crises such as the COVID-19 pandemic, the 2014 Ebola outbreak in West Africa, the 2016 Zika virus in Latin America, and the ongoing polio eradication effort.
The emergency declaration serves mostly as a call to bring more global resources and attention to an epidemic. Past announcements have had a mixed impact, given that the UN health agency has been largely powerless to push countries to act.
Last month, WHO’s expert panel said the global monkeypox outbreak did not yet constitute 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 circulating, mainly in Nigeria and the Congo.
In Africa, monkeypox is mainly spread to humans from infected wild animals such as rodents, in limited outbreaks that usually do not cross borders. In Europe, North America and elsewhere, however, monkeypox is spreading among humans without contact with animals or recent travel to Africa.
The WHO’s top expert on monkeypox, Dr Rosamund Lewis, said this week that 99% of all cases of monkeypox outside Africa were in men, and of those, 98% involved men who have sex with men . Experts suspect that monkeypox epidemics in Europe and North America were spread through sex at two raves in Belgium and Spain.
“Although I am declaring a public health emergency of international concern for the time being, this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” Tedros said. “That means this is an outbreak that can be stopped with the right strategies in the right groups.”
Emergency chief Ryan explained what preceded the CEO’s decision:
”(Tedros) found that the commission did not reach consensus even though there was a very open, very useful, very thoughtful debate on the issues, and that because he is not against the commission, what he recognizes is that there are deep complexities in this problem,” Ryan said. “There is uncertainty on all sides. And he reflects that uncertainty and his determination that the event” will be a global emergency.
Before Saturday’s announcement, Michael Head, senior research fellow in global health at the University of Southampton, said it was surprising the WHO had not yet declared monkeypox a global emergency, explaining that the conditions were likely met weeks ago.
Some experts doubted whether such a declaration would help, arguing that the disease was not severe enough to warrant attention and that rich countries fighting monkeypox already had the funds to do so; most people recover without needing medical attention, although the lesions may be painful.
“I think it would be better to be proactive and overreact to the problem rather than waiting to react when it’s too late,” Head said. He added that the WHO’s emergency declaration could help donors such as the World Bank provide funds to stop outbreaks both in the West and in Africa, where animals are the likely natural reservoir of monkeypox.
In the US, some experts speculate whether monkeypox may be on the verge of becoming an established sexually transmitted disease in the country, like gonorrhea, herpes and HIV.
“Ultimately, we’re seeing 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 this might be happening, but we need a globally coordinated response to bring it under control,” he said.
Ko called for testing to be immediately ramped up, saying that, like in the early days of COVID-19, there were significant gaps in surveillance.
“The cases we’re seeing are just the tip of the iceberg,” he said. “The window is probably closed for us to quickly stop the outbreaks in Europe and the US, but it is not too late to stop monkeypox causing massive damage to poorer countries without the resources to deal with it.”
In the US, some experts speculate that monkeypox could establish itself there as the latest sexually transmitted disease, with officials estimating that 1.5 million men are at high risk of infection.
Dr Placide Mbala, a virologist who heads the global health division at Congo’s National Biomedical Research Institute, said he hoped any global effort to stop monkeypox would be fair. Although countries including Britain, Canada, Germany and the US have ordered millions of doses of vaccine, none has gone to Africa.
“The solution must be global,” Mbala said, adding that any vaccines sent to Africa would be used to target those at highest risk, such as hunters in rural areas.
“Vaccination in the West may help stop the epidemic there, but there will still be cases in Africa,” he said. “If the problem is not solved here, the risk to the rest of the world will remain.”
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