Will this help stop the epidemic?

WHO Director-General Tedros Adhanom Ghebreyesus sounded the agency’s highest alarm on July 23, announcing the seriousness of the global monkeypox epidemic.Credit: Lindsay McKenzie/WHO

Over the weekend, the World Health Organization (WHO) declared the global outbreak of monkeypox a “Public Health Emergency of International Concern” (PHEIC). Researchers hope the declaration – the agency’s highest alert – could serve as a wake-up call to countries containing the spread of the virus that causes monkeypox.

Since the first cases outside of Africa were identified in May, more than 16,500 people have been confirmed infected in nearly 80 countries, where they are not normally detected. Monkeypox has been endemic in parts of Africa for decades.

This is the seventh time the WHO has declared a PHEIC since the alert system was created in 2005 — a step it reserves for events that pose a threat to multiple countries and require a coordinated international response (see “Highest alert”). Two of these warnings, against COVID-19 and polio, are still in place.

In an unprecedented move, WHO Director-General Tedros Adhanom Ghebreyesus announced the PHEIC on July 23 after a panel of advisers failed to reach a consensus. Although the panel did not formally vote, six members voted in favor of publishing the PHEIC and nine opposed, Tedros said at a news conference announcing his decision. The panel had previously met at the end of June, but at that time only three members announced PHEIC and 11 opposed, so Tedros decided to sound the alarm at that time.

The highest signal

The WHO has declared a Public Health Emergency of International Concern, or PHEIC, seven times since the alert system was created in 2005.

2009: H1N1 (swine flu) originates in Mexico and spreads to the United States.

2014: Polio is making a comeback in Afghanistan, Pakistan and Nigeria.

2014: Ebola virus has spread in Guinea, Sierra Leone and Liberia.

2016: Zika virus outbreak causes microcephaly and other neurological disorders in America.

2019: The Ebola epidemic has spread in the conflict-ridden region of the Democratic Republic of the Congo.

2020: The first cases of COVID-19 appeared in China in late 2019, and the SARS-CoV-2 coronavirus spread to many other countries and became a pandemic.

2022: Monkeypox infections are widespread in countries outside of Central and West Africa, where they have been slowly spreading for 50 years.

Source: This timeline has been modified from this storyBy Amy Maxman.

Declaring monkeypox a global emergency is the right decision, said Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who is a panel member and has studied monkeypox in the Democratic Republic of the Congo for more than a decade. . “It sends the right message and hopefully mobilizes attention and resources to prevent this virus from taking hold globally.”

The window closes

Scientists have warned that the window of opportunity to end the global monkeypox epidemic is closing fast. The virus has become established in animal reservoirs in parts of Africa and is difficult to eradicate. One risk is that the virus could spread from humans to animals in other parts of the world, creating reservoirs from which humans are repeatedly infected.

Although cases are increasing in Germany, Spain and the United States, some think restrictions are still possible. Caitlin Rivers, an epidemiologist at Johns Hopkins University in Baltimore, Maryland, sends a strong signal to public health officials at PHEIC in Baltimore that it’s time to act. “We cannot treat this as an endemic virus,” he says.

Countries should work to increase the number of people tested, step up contact tracing efforts and isolate people as early as possible after symptoms are detected, Rivers added.

PHEIC sends a clear message to countries that their participation in the global response, including the sharing of vaccines and treatments, is essential for coverage. The World Health Organization has issued guidelines for countries in the wake of the alert, providing recommendations for testing, public health measures and messages, travel advisories, infection prevention and control, and global coordination.

coverage concerns

Rich countries have raced to promote smallpox vaccines, which are believed to be highly effective against monkeypox because the viruses that cause the diseases are siblings. Although some children and women have been infected with monkeypox, almost all infections in the global epidemic have occurred among men who have sex with men (MSM), particularly men who have multiple sex partners. This has led health officials to focus messaging and vaccine stocks on this population. At first, some countries, such as Canada and the United Kingdom, used the “ring vaccination” method to cut off transmission from close contacts of people infected with monkeypox. They then moved quickly to expand the vaccine to high-risk communities, including MSM and healthcare workers.

Scientists know that monkeypox is spread mainly through close contact. They are still investigating whether the virus can be sexually transmitted, but it has been exposed in the MSM community. Some WHO members were reluctant to support the PHEIC declaration because they feared it would stigmatize the community and hinder efforts to contain the virus. “People don’t always want to disclose their sexual history,” especially in countries where homosexuality is criminalized, says Boguma Titanji, an infectious disease physician at Emory University in Atlanta.

Although wealthy countries use vaccines against monkeypox, Titanji warns of ongoing outbreaks in Africa, which have killed more than 70 people this year. (So ​​far, there have been no deaths in people infected outside of Africa.) He hopes the WHO will contribute to the global response to monkeypox by providing funding and helping to scale up surveillance and testing for the virus in Africa. Research and vaccines are there. “We have allowed this problem to grow in Africa for 50 years with monkeypox,” he says.

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