The World Health Organization has taken the extraordinary step of declaring a global emergency for the second time in two years. This time the cause is monkeypox, which has spread to dozens of countries within weeks, infecting thousands of people.
Dr. WHO Director-General Tedros Adhanom Ghebreyesus overruled a panel of advisers who failed to reach a consensus on Saturday and declared a “public health emergency of international concern,” a term the WHO currently uses to describe only two other diseases. Covid-19 and polio.
“We have an epidemic that is spreading rapidly around the world through new routes of infection that we understand very little and that meets very specific public health criteria,” said Dr. Tedros told journalists about it.
The committee’s failure to reach consensus also underscores the need for a better process for deciding which events represent public health emergencies. It appears to be the first time a CEO has overruled his advisers on declaring a public health emergency.
“This process once again shows that this important tool needs to be sharpened to make it more effective,” says Dr. Tedros said based on WHO consultations. Member countries are looking at ways to improve the process, he added.
The World Health Organization declares a public health threat that requires a coordinated international response declaration. The designation encourages member countries to commit significant resources to outbreak control, to commit more to the response, and to share vaccines, treatments, and other key resources to prevent outbreaks.
This is the seventh public health emergency since 2007; The Covid pandemic was, of course, the latest. Some global health experts have criticized the WHO’s criteria for declaring emergencies as vague and inconsistent.
At a meeting in June, WHO advisers concluded that while monkeypox is a growing threat, it is not an international emergency. On Thursday, the commission could not come to a decision, Dr. Tedros said.
Many experts have criticized this process as being jealous and overly cautious.
There are more than 16,000 cases of monkeypox outside Africa, five times more than when advisers met in June. Almost all infections were among men who had sex with men.
The WHO declaration said “better late than never”. Boguma Titanji, an infectious disease physician at Emory University in Atlanta.
What you need to know about monkeypox virus
What is monkey pox? Monkeypox is a virus that is endemic in parts of Central and West Africa. It is similar to chicken pox, but less severe. According to the Centers for Disease Control and Prevention, it was discovered in 1958 after the disease appeared in monkeys being held for research.
But with the delay, “the global response has suffered from a lack of coordination, with individual countries working at different paces to tackle the problem,” he said.
“There is almost a capitulation, we cannot stop the monkeypox virus in a more sustainable way,” he added.
Dr. James Lawler, co-director of the University of Nebraska’s Center for Global Health, said it could take a year or more to bring the outbreak under control. By then, the virus may have infected hundreds of thousands of people and become permanently entrenched in some countries.
“Now we have, unfortunately, missed the boat on fighting the epidemic in the past,” said Dr. Lawler said. “Now it’s going to be a real battle to contain and control the spread.”
The longer an outbreak lasts, the greater the chance that the virus will spread from infected humans to animal populations, where it can persist and cause new infections in humans. This is one way for a disease to become endemic in an area.
As of Saturday, nearly 3,000 cases had been reported in the United States, including two children, but the actual death toll is believed to be much higher because testing is only now being scaled up. The UK and Spain each have that many cases, with the rest spread across about 70 countries.
Most of those infected in these countries report no known source of infection, suggesting undetected community spread.
In late June, WHO advisers did not recommend declaring a state of emergency in part because the disease is not among the main risk groups, affecting men who have sex with men, pregnant women, children or the elderly. If they are infected, they are at greater risk of severe disease.
In the interviews, some experts agreed and disagreed with the reasoning.
“Do you really want to declare a state of emergency, or do you want to do it in advance?” said Dr. Isabella Eckerle, a clinical virologist at the University of Geneva.
“We don’t have such a problem now. We do not detect the virus in children and pregnant women,” he added. “But we know that if we let it happen and don’t do enough, it will happen at some point.”
A similar WHO committee, which agreed to assess the coronavirus outbreak in early 2020, met twice more and made a unanimous decision at its second meeting on January 2. 30 virus outbreak, public health emergency.
Committee members at the time recommended that the WHO consider creating a “moderate alert” for moderate concerns. An organization may need such a system because outbreaks occur frequently.
Deforestation, globalization and climate change are creating more opportunities for pathogens to jump from animals to humans. Now a new virus can quickly cross national borders and become a global threat.
But most health facilities are only equipped to deal with chronic diseases or small outbreaks.
The devastation of the Covid pandemic and the rise of monkeypox should be a warning to governments to prepare for new outbreaks without warning, said Tom Inglesby, director of the Johns Hopkins Health Center at the Bloomberg School of Public Health.
“As much as the world is tired of infectious disease crises, they are part of the new normal that will require more attention and resources,” he said. “We need global methods to produce and store vaccines and therapeutics, but we don’t have them yet.”
Monkeypox has been endemic in some African countries for decades. Experts have been sounding the alarm about its potential as a global threat for years, but their warnings have largely gone unheeded.
Vaccines and drugs fear a bioterror attack with smallpox, a close relative of the monkeypox virus.
But the time-consuming red tape and government oversight of accessing the drug, called tecovirimat, is delaying treatment for days or even weeks for some patients.
Doses of the newer and safer Jynneos of the two available vaccines are severely limited — even in the U.S., which helped develop the vaccine.
As of Friday, New York had 839 cases of monkeypox, almost all of them in men who have sex with men, according to the city’s Department of Health. In late June, the city began offering the monkey vaccine, but ran out of about 1,000 doses.
Since then, the supply has gradually increased to 20,000 doses. The city offered another 17,000 first-dose appointments Friday night, but those also quickly filled up.
“Vaccine supplies remain low,” the city health department’s website said Saturday.
Containing the virus can be even more difficult in countries with limited or no vaccines and treatments. In the context of a global emergency, each country must find its own way to provide tests, vaccines and treatment, increasing inequality between countries.
Lack of response coordination has led to missed data collection opportunities in large multinational studies, particularly where disease surveillance is accurate.
“Because of the inability to characterize the epidemiological situation in this region, it creates a serious challenge for the development of measures to control this historically neglected disease,” said Dr. Tedros spoke about the West and Central African countries in a statement on Thursday.
For example, cases of monkeypox in Nigeria and the Democratic Republic of the Congo, where the virus is endemic, can cause a painful rash within a week or two of infection.
However, in the current outbreak, many patients developed lesions only in the genital area. Some had severe pain, especially those with ulcers in the throat, urethra, or rectum.
“I was afraid to use the bathroom,” said one patient recently, Gabrielle Morales, 27, a part-time model living in New York City. “I can’t even describe it. It feels like broken glass.’
Many other patients experienced only mild symptoms, and some had no fever, body aches, or respiratory symptoms.
Severe cases may have been identified only in endemic areas of Africa, and the current outbreak offers a clearer picture of the disease, Dr. Eckerle said. Or the virus itself and its symptom profile may have changed significantly.
According to preliminary genetic analysis of samples from infected patients, the monkeypox genome appears to have accumulated about 50 mutations since 2018, more than the six or seven mutations expected to accumulate during that period.
It is not yet known whether the mutations change the mode of transmission, severity or other characteristics of the virus. But preliminary analyzes suggest that monkeypox may have adapted to spread more easily between humans than it did in 2018.
Coordinating the response among nations will help address many of the uncertainties surrounding the outbreak, Dr. Eckerl said, “There are so many open questions.”
Joseph Goldstein the and Sharon Otterman contributed reporting.