Why declaring monkeypox a global health emergency is a precautionary step – not a reason to panic

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

In response, the director-general of the World Health Organization, Tedros Adhanom Ghebreyesus, convened an emergency monkeypox committee to track the developing situation. At the committee’s first meeting on June 23, 2022, members noted that the “multi-country outbreak” could stabilize as case counts fell in some countries.

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

As a global health expert specializing in the epidemiology of infectious diseases, I don’t think most people should worry about monkeypox. This WHO decision, while it may sound ominous, is not a sign of bad things to come. Rather, it is a way to prevent monkeypox from becoming a global crisis.

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

The Director-General of the World Health Organization has the power to declare an event a public health emergency of international concern. (Guilhem Vellut | WikiMedia Commons, CC BY 2.0)

The International Health Regulations are a set of rules that guide how WHO and United Nations member states 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 when three criteria are met: the situation is an “extraordinary event”, there is a risk of spread to other countries, and the situation may “potentially require a coordinated international response”.

Before monkeypox, only five diseases had been designated as PHEICs since the WHO began using the term in 2005: the H1N1 influenza pandemic in 2009; the re-emergence of polio 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 Congo in 2019; the spread of the Zika virus in the Americas in 2016; and the coronavirus pandemic in 2020. While all of these events were important, only the coronavirus pandemic became a worldwide catastrophe.

Why is monkeypox a public health emergency of international concern?

The WHO Director-General is the only person who can declare a PHEIC, but the decision is based on the advice of the designated emergency committee. After the monkey emergency committee met for the second time, on 21 July 2022, it released a report stating that “the monkeypox outbreak in many countries meets all three criteria that define a PHEIC”.

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

However, the committee did not unanimously agree that a public health emergency of international concern should be declared. Some members asked whether a disease that has a low mortality rate should be PHEIC. Others worried that a PHEIC designation could further stigmatize LGBTQ communities since most cases so far have been diagnosed among men who have sex with men.

The emergency committee vote was split nine against and six for PHEIC status. But Director-General Tedros decided 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. WHO has two initial goals for monkeypox. First, to try to stop the virus from circulating 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.

Following the PHEIC statement, WHO issued a series of interim recommendations urging countries to do more to prevent 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 require countries to advise infected individuals and their direct contacts not to travel except in emergency situations, but they do not place 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 behavioral change in the general public.

A public health emergency of international concern is the highest level of alert in the International Health Regulations, but is not synonymous with a pandemic. The status is a means of protecting the health of the global population and not a declaration that a global crisis is already occurring.Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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