The Director-General of the World Health Organization (WHO) declared monkeypox to be a public health emergency of international concern (PHEIC), taking the rare step of overruling a WHO committee convened to consider the matter.
“The WHO Director-General is taking the opportunity to express his sincere gratitude to the chairs and members of the committee, as well as to its advisors, for their careful consideration of the issues regarding this outbreak, as well as for providing invaluable input for his consideration,” Tedros Adhanom Ghebreyesus, PhD, said in a statement posted Saturday. “The committee members did not reach a consensus regarding their advice on determination of a PHEIC for this event.”
“The WHO Director-General recognizes the complexities and uncertainties associated with this public health event,” he continued. “Having considered the views of committee members and advisors as well as other factors in line with the International Health Regulations, the Director-General has determined that the multi-country outbreak of monkeypox constitutes a [PHEIC].”
A total of 15 out of 16 members of the WHO’s International Health Regulations (2005) Emergency Committee, as well as its 10 advisors, participated in a Zoom meeting about the issue on Thursday. Those who supported declaring the PHEIC cited several reasons, including:
- The multi-country outbreak of monkeypox meets all the three criteria defining a PHEIC: it’s 1) an extraordinary event that 2) constitutes a risk to many countries through the international spread of disease, and 3) it may potentially require a coordinated international response
- There is a “moral duty” to deploy all means and tools available to respond to the event, as highlighted by leaders of the LGBTQIA+ communities from several countries
- The number of cases being reported globally is rising, and are likely to be an underestimate of the actual magnitude of the outbreaks
- Monkeypox cases are being reported in children and pregnant women, which are reminiscent of the initial phases of the HIV pandemic
- The modes of transmission sustaining the current outbreak are not fully understood
Those opposing a PHEIC declaration also had several reasons, which included:
- The overall global risk assessment presented by the WHO Secretariat remained unchanged compared to its June 23 report
- The greatest burden of the outbreak is currently reported in 12 countries in Europe and in the Americas, “with no indications, based on currently available data, of an exponential increase in the number of cases in any of those countries” and early signs of stabilization or declining trends observed in some countries
- The vast majority of cases are observed among men who have sex with men (MSM) with multiple partners, and ongoing transmission can be stopped with interventions targeted to that specific population
- Disease severity is perceived to be low
- The epidemic is gaining maturity and clearer indications about the effectiveness of policies and interventions are being generated
In a report released Friday, the WHO noted that a total of 15,328 laboratory confirmed monkeypox cases and 72 probable cases, including 5 deaths, had been reported to the agency. Since May 13, “a high proportion of these cases have been reported from countries without previously documented monkeypox transmission,” the report said. Of the documented cases, 72 were in children, including 23 in children 0-4 years old.
In the U.S., the CDC reported 2,891 cases as of Friday, with the highest number of cases being in New York (900), followed by California (356) and Florida (247). Six states — Montana, Wyoming, Alaska, Mississippi, Maine, and Vermont — had no reported cases.
HHS Secretary Xavier Becerra called the WHO declaration a “call to action for the global health community.”
“Monkeypox has spread around the world and we will continue to take decisive action to tackle it both here in the U.S. and, working in concert with our partners abroad, globally,” Becerra said Saturday in a statement. “Since the first U.S. case of monkeypox was confirmed on May 18, the Biden-Harris Administration has acted swiftly to make vaccines, testing, and treatments available to people in need. We are determined to accelerate our response in the days ahead.”
On Friday, Ashish Jha, MD, MPH, the White House COVID-19 Response Coordinator, said in a call with reporters that whether to invoke a public health emergency for monkeypox in the U.S. “is an ongoing, but a very active conversation at HHS,” adding that if it did happen, “this declaration would be from the Department of Health and Human Services; it would not be a White House declaration.”
Jha repeated that sentiment Sunday on CBS’s Face the Nation, saying that the administration “is right now looking at a public health emergency as something that HHS might invoke, but it depends on, what does that allow us to do? Right now we have over 2,000 cases, but we’ve ramped up vaccines, ramped up treatments, ramped up testing, and we’re going to continue looking at all our policy options.”
“I do think monkeypox can be contained,” he continued. “We have a simple straightforward strategy on this: make testing widely available — we have the capacity to do 80,000 tests a week — and we’re going to be releasing hundreds of thousands more vaccines in next days and weeks, so there’s a very substantial ramping up of response that’s happening right now … The plan is to eliminate this virus from the U.S. I think we can do that.”
He acknowledged a report that the virus has been found in two children in the U.S., adding that “we’re working with physician groups to do more broad-scale testing.”
Enterprise & Investigative Writer Amanda D’Ambrosio contributed to this story.
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