WHO declares monkeypox an international health emergency

The designation does not require countries to take new action to combat the virus, but sounds the alarm to address the threat of outbreaks — even if Covid-19 and polio remain active international public health emergencies.

“WHO assesses the risk of monkeypox globally as moderate, with the exception of the European region, where we assess the risk as high,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement. “With the tools we have right now, we can stop the transmission and bring this outbreak under control.”

A month ago, the WHO convened a meeting to determine whether monkeypox was PHEIC, but then it decided it was not, despite the fact that some advisers disagreed with the call. At that time, there were about 3300 cases of the disease in the world, 150 of them in the USA.

There are currently over 16,800 cases worldwide, with nearly 2,900 in the US.

However, many questions remain unanswered, including why so many new infections are reported in countries where the virus was not endemic. These cases have already led to increased demand for vaccines and therapeutics that could be used to stop the spread and treat those already infected.

The WHO’s decision came despite the fact that its emergency committee was unable to reach a consensus on whether the virus constituted an international health emergency. But the declaration adds a new international urgency to the already rushed effort to get case files in.

“We are in a kind of paradoxical situation with monkeypox,” Piero Olliaro, a University of Oxford researcher who advised WHO members on monkeypox research priorities, told POLITICO on Wednesday via email. “On the one hand, our knowledge of the clinical manifestations and outcomes of monkeypox in the Western world is improving, and we even have potentially one or more treatments and a vaccine, on the other hand, we still have little evidence to support which intervention should be undertake. used, and how to break the chains of transmission and how to conduct business efficiently.”

The fight for vaccines and therapeutics

Also, unlike Covid-19, vaccines and therapeutics that can be used to treat monkeypox already exist, although many are approved for smallpox and face regulatory barriers to full approval.

Jynneos, a third-generation smallpox vaccine that has also been approved for monkeypox in some countries, has so far been seen as the best choice for outbreak control despite relatively few doses available worldwide. The US has sent more than 300,000 doses of the vaccine, and millions more are on the way to make up the shortfall in states and cities. And countries have done the same: European countries ordered more than a million doses earlier this month.

In its original guidance, WHO included two other vaccine options for potential use in monkeypox patients. Another third-generation vaccine is currently only in stock in Japan, although the WHO is in talks with the country to expand access, Rosamund Lewis, WHO’s monkeypox technical lead, told POLITICO.

The third vaccine on the list, ACAM2000, is available in much larger quantities. The US holds about 100 million doses of the second-generation vaccine in its reserves, although it has not been officially approved in the US for the treatment of monkeypox, except for use as a new experimental drug.

And the struggle for resources extends not only to vaccines, but also to antiviral drugs. Tecovirimat, an orthopox antiviral drug promising for the treatment of monkeypox, is in relatively short supply worldwide. Siga, the small company that makes Tecovirimat, is in talks with dozens of countries to order the drug and hopes to increase its production capacity.

Beyond the declaration

Declaring monkeypox a public health emergency of international concern will likely not change what countries are doing to fight the virus. Orders for vaccines and therapeutics, along with expanded testing and public announcements, will continue.

Before Saturday’s announcement, US officials discussed how to raise your own answerincluding by declaring a public health emergency and finding ways to more effectively distribute limited doses to large populations.

Global health equity has been a critique of the early monkeypox response – as it was during the pandemic – with few endemic countries having access to countermeasures that are now more widely used.