For the second time in two years, the World Health Organization has taken the extraordinary step of declaring a global emergency. The reason this time is monkeypox, which within a few weeks spread to dozens of countries and infected tens of thousands of people.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, on Saturday canceled a panel of advisers, who were unable to reach consensus, and declared a “public health emergency of international concern,” a designation the WHO is currently using to describe two others. Only diseases, covid-19 and polio.
“We have an outbreak that has spread across the world rapidly with new routes of transmission, of which we understand very little, and that meet the criteria” for a public health emergency, Dr Tedros told reporters.
The Committee’s inability to reach consensus also highlights the need for a better process for identifying events as public health emergencies. This appears to be the first time the Director-General has pounced on his advisors to declare a public health emergency.
“This process shows once again that this vital tool needs more precision to make it more effective,” said Dr. Tedros, referring to the WHO’s deliberations. He added that member states were studying ways to improve the process.
The WHO declaration indicates a public health risk that requires a coordinated international response. This appointment could lead member states to invest significant resources in controlling the outbreak, withdraw more funding for the response, and encourage states to share vaccines, treatments and other key resources to contain the outbreak.
It is the seventh public health emergency since 2007; And, of course, the Covid pandemic was the latest. Some global health experts have criticized WHO standards for declaring emergencies as opaque and inconsistent.
At a meeting in June, WHO advisers concluded that while monkeypox was an increasing threat, it was not yet an international emergency. Dr Tedros said the committee was unable to reach a decision on Thursday.
Many experts have harshly criticized the process, calling it short-sighted and excessively cautious.
There are more than 16,000 cases of monkeypox outside Africa, nearly five times the number when advisers met in June. Almost all infections have occurred among men who have sex with men.
Bogoma Titanji, an infectious disease physician at Emory University in Atlanta, said the WHO announcement was “better late than never.”
What do you know about the monkeypox virus?
What is monkeypox? Monkeypox is a virus that is endemic in parts of central and western Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
But with the delay, “one could argue that the response globally has continued to suffer from a lack of coordination with individual countries working at very different steps to address the problem.”
“There is almost a capitulation that we cannot prevent the monkeypox virus from establishing itself in a more permanent way,” she added.
Dr. James Lawler, co-director of the University of Nebraska’s Global Center for Health Security, estimated that it could take a year or more to bring the outbreak under control. By then, the virus will likely have infected hundreds of thousands of people and may have taken root permanently in some countries.
“We’ve now really unfortunately missed the boat for being able to put a lid on the outbreak earlier,” said Dr. Lawler. “Now it will be a real struggle to be able to contain and control the spread.”
The longer the outbreak lasts, the greater the chances of the virus passing from infected people to animal populations, where it can persist and intermittently lead to new infections in humans. This is one of the ways in which the disease can be endemic in an area.
As of Saturday, the United States had recorded nearly 3,000 cases, including two children, but the true number is believed to be much higher, as testing is only now being scaled up. Britain and Spain have about the same number, the rest are distributed in about 70 countries.
Many infected people in these countries reported no known source of infection, indicating undetected community spread.
WHO advisers said at the end of June that they had not recommended an emergency declaration in part because the disease had not moved from the primary risk group, men who have sex with men, to affect pregnant women, children or the elderly, who are more likely to become seriously ill. If they are infected.
In interviews, some experts said they did not agree with the rationale.
“Do you want to declare an emergency the moment it’s really bad, or do you want to do it in advance?” Dr Isabella Eckerly, a clinical virologist at the University of Geneva said.
“We don’t have that problem now. We don’t see the virus in babies and we don’t see it in pregnant women.”
A similar committee of the World Health Organization that met in early 2020 to assess the outbreak of the Corona virus met twice, and only decided at its second meeting, on January 30, that the spread of the virus constituted a public health emergency.
Committee members at the time suggested that the World Health Organization consider establishing a “medium level of alert” for outbreaks of diseases of moderate concern. The organization may need such a system as outbreaks become more frequent.
Deforestation, globalization and climate change are creating more opportunities for pathogens to jump from animals to humans. Now, the emerging virus can rapidly transcend national borders to become a global threat.
But most public health authorities are still only equipped to deal with chronic diseases or small outbreaks.
Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, said the devastation wrought by the Covid pandemic and the upsurge in monkeypox should serve as a warning to governments to prepare for new pandemics without warning.
“As tired as the world is of infectious disease crises, they are part of a new normal that will require a lot of ongoing attention and resources,” he said. “We need global approaches to producing and stockpiling vaccines and treatments that do not yet exist.”
Monkeypox has been raging periodically in some African countries for decades. Experts have sounded the alarm about the possibility of it being considered a global threat for years now, but their warnings have mostly gone unheeded.
Vaccines and medications are available in large part due to fears of a bioterrorist attack with smallpox, a close relative of the monkeypox virus.
But access to a drug called tecovirimat has been bogged down by time-consuming bureaucracy and government control of the supply, delaying treatment for days or even weeks for some patients.
Doses of Jynneos, the newer and safer of the two available vaccines, have been severely restricted — even in the United States, which helped develop the vaccine.
As of Friday, New York City had recorded 839 cases of monkeypox, nearly all of them men who had sex with men, according to the city’s health department. In late June, the city began offering the monkeypox vaccine, but it only ran out of nearly 1,000 doses.
The supply has since grown slowly to about 20,000 doses. The city offered another 17,000 appointments for the first dose on Friday evening, but those appointments also filled up quickly.
“Vaccine supplies remain low,” the city’s health department website said on Saturday.
Containing the virus may be more difficult in countries with limited or no supplies of vaccines and treatments. Without the framework of a global emergency, each country must find its own way to deliver tests, vaccines, and treatments, exacerbating inequality between nations.
Failure to coordinate the response has also led to missed opportunities for data collection in large multinational studies, particularly where disease surveillance tends to be sporadic.
“The inability to describe the epidemiological situation in that region presents a major challenge to designing interventions to control this historically neglected disease,” Dr. Tedros said of West and Central African countries in a statement Thursday.
For example, cases of monkeypox in Nigeria and the Democratic Republic of the Congo, where the virus has been endemic, suggest that a painful body-wide rash can develop within 1-2 weeks after exposure.
But many patients in the current outbreak developed lesions in the genital area only. Some – especially those who develop sores in the throat, urethra, or rectum – are in excruciating pain.
“I was afraid to actually use the bathroom,” said one of the new patients, Gabriel Morales, 27, a part-time model in New York City. “I can’t even describe it. It feels like broken glass.”
Many other patients experienced only mild symptoms, and some did not have the fever, body aches, or respiratory symptoms normally associated with the disease.
Dr Eckerl said it’s possible that severe cases have only been detected in endemic areas of Africa, and that the current outbreak provides a more accurate picture of the disease. Or it could be that the virus itself has changed dramatically, and the characteristics of the symptoms it causes have also changed.
According to preliminary genetic analyzes of samples from infected patients, the monkeypox genome appears to have collected nearly 50 mutations since 2018, more than six or seven that were expected to collect in that period.
It is unclear whether the mutations changed the mode of transmission, severity or other characteristics of the virus. But early analyzes suggest monkeypox may have adapted to spreading among people more easily than it did before 2018.
Dr Eckerl said that coordinating the response between countries would help address many of the uncertainties around the outbreak: “There are a lot of open questions.”
Joseph Goldstein And the Sharon Outerman Contribute to the preparation of reports.