A growing epidemic of monkeypox in more than 70 countries is an “extraordinary” situation that qualifies as a global emergency, the head of the World Health Organization said on Saturday, a declaration that could spur further investment in treating the once-rare disease and exacerbated the struggle for scarce vaccines.
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. Similar declarations were made for the 2016 Zika virus in Latin America and ongoing polio eradication efforts, in addition to the COVID-19 pandemic and the 2014 Ebola outbreak in West Africa.
WHO Director-General Tedros Adhanom Ghebreyesus made the decision to call monkeypox a global emergency despite a lack of consensus among experts on the UN health agency’s Emergency Committee, saying it had acted as a “break”. It was the first time the head of a UN health agency had made such a unilateral decision without expert advice.
“We have an outbreak that has spread rapidly around the world through new modes of transmission that we understand too little about,” Tedros said. “I know this is not an easy or straightforward process and that there are different points of view.
The WHO’s head of emergencies, Dr Michael Ryan, said the director-general had declared monkeypox a global emergency to ensure the world took 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.
Last month, the WHO expert panel said the 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 through 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.
“While I am currently declaring a public health emergency of international concern, this is an outbreak that is concentrated among men who have sex with men, particularly those with multiple sexual partners,” Tedros said. “That means it’s an outbreak that can be stopped with the right strategies.”
Britain recently downgraded its assessment of monkeypox after seeing no signs of widespread transmission outside of men who are gay, bisexual or have sex with men, and noted that the disease does not spread easily or cause severe illness.
The US Centers for Disease Control and Prevention said it “supports” the WHO’s emergency declaration and hopes it will spur international action to stamp out the outbreaks. The US has reported more than 2,800 cases of monkeypox and has shipped more than 370,000 doses of vaccine to US states that have reported cases.
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.
Michael Head, a senior fellow in global health at the University of Southampton, said the WHO’s emergency declaration could help donors such as the World Bank provide funds to stop outbreaks in both the West and Africa.
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.
“The bottom line is that we are seeing a shift in the epidemiology of monkeypox where there is 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.”
Ko called for an immediate increase in testing, saying 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.”
The WHO’s Tedros called on the world to “act together in solidarity” to spread treatments, tests and vaccines. for monkeypox. The UN agency previously said it was working to create a mechanism to share vaccines for the most affected countries, but offered few details on how it might work. Unlike the many companies that make vaccines against COVID-19, there is only one manufacturer of the monkeypox vaccine, Denmark’s Bavarian Nordic.
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 monkeypox 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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