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July 25, 2022

'We're losing daylight': As monkeypox spreads, WHO declares a public health emergency

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    The World Health Organization (WHO) on Saturday declared monkeypox a public health emergency of international concern (PHEIC). Meanwhile, epidemiologists are warning the window is closing for the United States to contain the spread of the virus.

    Why the US response to monkeypox is drawing comparisons to Covid-19

    WHO declares public health emergency

    According to WHO Director General Tedros Adhanom Ghebreyesus, WHO has received reports of more than 16,000 monkeypox cases from 75 countries and territories, as well as five deaths.

    In a press conference on Saturday, Tedros announced that WHO had declared monkeypox a PHEIC. This means it is a serious, sudden, unusual, or unexpected situation with public health implications beyond the borders of a country and it could require international action.

    The PHEIC gives WHO certain powers, such as the ability to recommend how countries should respond and rally global coordination for a unified response, including ensuring equitable distribution of vaccines and treatments.

    "WHO's assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high," Tedros said.

    Tedros added that there is a "clear risk" for international spread, but the risk of monkeypox interfering with international traffic is low.

    "So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulation," he said.

    The outbreak is mostly concentrated among men who have sex with men (MSM), according to Tedros, which "means that this is an outbreak that can be stopped with the right strategies in the right groups."

    Countries should work with communities of MSM to provide information and support, and to adopt measures protecting the "health, human rights, and dignity of affected communities."

    Reaction to WHO's declaration

    Some members of WHO's emergency committee expressed concern about issuing a PHEIC for monkeypox, saying that it could lead to mistreatment and stigmatization of MSM.

    "It is exceptionally important that the existence of a public health emergency of international concern and the intensification of surveillance and control efforts are not used as a means of coercive surveillance or for imposition of measures that would impede the dignity and human rights of the people affected," said Mike Ryan, leader of WHO's Health Emergencies Program. "It's very important that we get this balance right."

    Boghuma Titanji, an infectious diseases physician at Emory University, said WHO's declaration is "better late than never." But she added that with the organization's delay, "one can argue that the response globally has continued to suffer from a lack of coordination with individual countries working at very different paces to address the problem."

    James Lawler, co-director of the University of Nebraska's Global Center for Health Security, said he believes it could take at least a year to control the monkeypox outbreak, and by then, the virus could have infected hundreds of thousands and permanently embedded itself within some countries.

    "We've now unfortunately really missed the boat on being able to put a lid on the outbreak earlier," Lawler said. "Now it's going to be a real struggle to be able to contain and control spread."

    How the US is responding

    In response to WHO's declaration, the National Coalition of STD Directors called on the Biden administration to declare monkeypox a national public health emergency, and to allocate $100 million in emergency funding.

    "While the administration has taken steps to address the monkeypox outbreak including accelerating the distribution of vaccines and allocating critical funding for monkeypox research, it quite simply is not enough," said David Harvey, executive director of the group.

    "Cities and states around the country have been left to respond to this outbreak on their own, making impossible decisions about how and when to allocate vaccines, provide therapeutics that are needed to recover, and educate the public," he added.

    As of Friday, CDC reported 2,891 cases of monkeypox in the United States. Generally, the cases have been concentrated among MSM, however some cases have been reported among cisgender women. On Friday, CDC Director Rochelle Walensky announced the agency has confirmed the first two monkeypox cases in children.

    According to Walensky, both children "are doing well" and "are traced back to individuals who come from the men-who-have-sex-with-men community," adding that the cases are both "likely the result of household transmission."

    HHS is considering whether to declare monkeypox a U.S. public health emergency, according to Ashish Jha, the White House Covid-19 coordinator.

    "I think with public health emergencies, it's always important to ask very specific questions about what exactly would that allow us to be able do differently than we're doing now, and would that make it easier to be able to respond to this outbreak," he said. "It's an ongoing but a very active conversation at HHS."

    The White House has also announced a $140 million research agenda to better understand monkeypox. Coordinated through the White House Office of Science and Technology, the effort will gather data on how the virus is changing, why it's spreading so much in non-endemic countries, and how to communicate to the public about the outbreak.

    Epidemiologists have warned that the United States is running out of time to contain monkeypox. "We're losing daylight," said Anne Rimoin, an epidemiologist at the University of California, Los Angeles. "Every day that we aren't continuing to push forward on all fronts, the less likely it is that we will be able to contain it."

    Containment is "going to be tough, but that still needs to be the goal," said Preeti Malani, an infectious disease specialist at the University of Michigan. "What we do in the coming days and weeks will really determine where we are a few months from now."

    "I absolutely think that it can be contained. But whether it will be depends upon the resources dedicated to doing this and the speed with which we can act," Rimoin said. "It really will require a major concerted effort locally, nationally, and globally." (Gans, The Hill, 7/23; Branswell, STAT News, 7/23; Mandavilli, New York Times, 7/23; Cheng, Associated Press, 7/23; Chen, Axios, 7/23; Payne, PoliticoPRO [subscription required], 7/21; Sullivan, NPR, 7/25; Mueller, The Hill, 7/24)

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