Why declaring monkeypox a global health emergency is a precautionary step

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The monkeypox virus, which causes a rash and other symptoms, can be transmitted between people through close contact.

Countries that are members of the United Nations are required to report cases of unusual diseases that have the potential to become global health threats. In May 2022, more than a dozen nations in Europe, America and other regions of the world that had never had cases of monkeypox before began reporting cases within their borders.

Monkeypox is a rare disease caused by infection with the monkeypox virus, which belongs to the same virus family as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms but are milder and rarely fatal. Monkeypox is not related to chickenpox.

In response, Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, convened a monkeypox emergency committee to follow the evolution of the situation. At the committee’s first meeting on June 23, 2022, members believed that the “multi-country outbreak” may be stabilizing as case numbers had plateaued in several countries.

However, after thousands more cases of monkeypox were diagnosed in dozens of countries in July, it became clear that the outbreak had not leveled off. On July 23, 2022, Tedros declared monkeypox a public health emergency of international concern.

As a global health expert specializing in infectious disease epidemiology, I don’t think most people need to worry about monkeypox. While it may sound ominous, this WHO decision is not a sign that bad things are to come. Rather, it is a way to prevent monkeypox from becoming a global crisis.

World Health Organization headquarters

The Director-General of the World Health Organization has the authority to declare an event a public health emergency of international concern. Guilhem Vellut/Wikimedia Commons,

What is a Public Health Emergency of International Concern (PHEIC)?

The International Health Regulations are a set of rules that guide how Member States of the WHO and the United Nations respond to emerging health threats.

Under current regulations, a “Public Health Emergency of International Concern” – often abbreviated as PHEIC – can be declared by the WHO Director-General if three criteria are met: The situation is an “extraordinary event”, there is a risk that it will become An “extraordinary event” is spreading to other countries and the situation “may require a coordinated international response”.

Prior to monkeypox, only five diseases have been labeled PHEIC since WHO began using the term in 2005: the H1N1 flu pandemic in 2009; polio resurgence in Afghanistan, Nigeria and Pakistan in 2014; the Ebola epidemic in Guinea, Liberia and Sierra Leone in 2014 and an Ebola outbreak in the Democratic Republic of the Congo in 2019; the spread of the Zika virus in America in 2016; and the[{” attribute=””>COVID-19 pandemic in 2020. While all of these events were noteworthy, only the coronavirus pandemic became a worldwide catastrophe.

Why is monkeypox a public health emergency of international concern?

Although the director-general of the WHO is the only person who can declare a PHEIC, the decision is based on advice from the designated emergency committee. After the monkeypox emergency committee met for the second time, on July 21, 2022, it released a report stating that “the multi-country outbreak of monkeypox meets all the three criteria defining a PHEIC.”

The rapid spread of the virus to more than 70 countries was strong evidence of the risk of further international spread. Also, the committee expressed concerns about whether vaccines would be priced reasonably and distributed equitably in the absence of a coordinated international response. Furthermore, it agreed that there were aspects of the situation that were “extraordinary” – a vague term that is not defined in the International Health Regulations.

However, the committee was not in unanimous agreement that a public health emergency of international concern should be declared. Some members questioned whether a disease that has a low case fatality rate should be a PHEIC. Others worried that a PHEIC designation could further stigmatize LGBTQ communities because most cases thus far have been diagnosed among men who have sex with men.

The vote from the emergency committee was split – nine against and six for PHEIC status. However, Director-General Tedros opted to go ahead and declare monkeypox a PHEIC.

What happens now?

The goal of a PHEIC designation is to prevent an emerging disease from becoming a global health crisis. The WHO has two initial goals for monkeypox. First, to try to stop the virus from beginning to circulate in susceptible populations where it is not currently present. And second, to distribute vaccines and antiviral medications to the countries and communities that need them most.

After the PHEIC declaration, the WHO released a set of temporary recommendations that asks countries to work harder on preventing cases in affected and at-risk communities, to improve clinical care for people with monkeypox, and to contribute to research on vaccines and treatments for monkeypox. The recommendations also ask countries to advise infected individuals and their direct contacts not to travel except in urgent situations, but they do not impose any restrictions on international travel or trade.

Finally, the WHO has advised that individuals who are members of at-risk communities take steps to protect themselves from the virus, but has not called for changed behavior in the general public.

A public health emergency of international concern is the highest level of alert in the International Health Regulations, but it is not a synonym for a pandemic. The status is a tool for protecting global population health and not a declaration that a global crisis is already happening.

Written by Kathryn H. Jacobsen, William E. Cooper Distinguished University Chair, Professor of Health Studies, University of Richmond.

This article was first published in The Conversation.The Conversation

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