Why monkeypox was declared a global health emergency


Analysis: The WHO considers the epidemic to be “an extraordinary event” which poses a risk to public health through international transmission

By Paul Hunter, University of East Anglia

The World Health Organization (Who has declared the stream monkey pox epidemic a global health emergency. The committee of independent advisers which met on Thursday July 21 was divided on whether or not to classify the growing epidemic of monkeypox as a public health emergency of international concern – the highest level of alert.

The head of the WHO, Dr Tedros Adhanom Ghebreyesus, broke the deadlock and declared the outbreak a public health emergency. This is the first time that the Director General of the WHO dodged his advisers declare a public health emergency.

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From RTE Six One News in May, first case of Monkeypox recorded in Ireland

The first case of monkeypox was reported in a child in the Democratic Republic of the Congo (then Zaire) in 1970. Outbreaks since then have generally been small and attributable to an individual who recently returned from a country where the virus is endemic – c i.e. i.e. West and Central African countries. But the current outbreak is unlike any other outside of Africa in that there is continuous person-to-person transmission of infection.

As of July 22, there have been 16,593 confirmed infections in 68 countries who have never reported monkeypox. Most infections have been reported in Europe. The vast majority of infections are in men who have sex with men, especially men who have sex with multiple partners.

Models presented to the WHO suggest the average number of people infected by a single infected person (the so-called R nothing – remember this from the early days of the covid pandemic?) is between 1.4 and 1.8 inches men who have sex with men, but less than 1.0 in other populations. Thus, although occasional infections may spread to populations other than men who have sex with men, significant further spread is unlikely.

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According to BBC News, the WHO has declared monkeypox a global health emergency following a global upsurge in cases.

In Europe, in recent weeks, there has been a slowdown in growth rate in new cases of monkeypox every week. The vast majority of infections still occur in men who have sex with men. In the UK, 97% of cases are in men who have sex with men, but it appears the epidemic’s growth rate has fallen to zero or even turned negative in recent weeks. But it is plausible that the apparent decline in new infections is the gap between consecutive waves.

Experts have recently debated whether monkeypox is now a sexually transmitted disease. Although monkeypox is undoubtedly transmitted during sex, labeling it an STD would be counterproductive, as the infection could be spread through any intimate contact, even while wearing condoms or without penetration.

Confirmed cumulative cases of monkeypox in the current outbreak. Our world in data, CC BY

For and against the declaration of a global health emergency

Broadly speaking, the WHO emergency committee’s arguments for declaring a global health emergency included the fact that monkeypox satisfied the requirement of a public health emergency of international concern under the WHO International Health Regulations: “an extraordinary event, which poses a public health risk to other States through international transmission, and which potentially requires a coordinated international response”.

Added to this are concerns that in some countries there is likely to be significant under-reporting of case numbers, occasional reports of infections in children and pregnant women, fear infections could become endemic in human populations or be reintroduced to at-risk groups even after the current monkeypox pandemic ends.

Arguments against declaring a global health emergency included the fact that the vast majority of infections are currently seen in just 12 countries in Europe and North America. There is evidence that cases are stabilizing or even declining in these countries.

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From RTÉ Radio 1’s Drivetime, Cillian de Gascun from the National Virus Reference Laboratory on monkeypox cases in Ireland

Almost all cases involve men who have sex with men and have multiple partners, providing opportunities to stop transmission with interventions targeted at this group. Another argument is that the severity of the disease on the outside seems low. Although the emergency committee was unable to reach a consensus, Tedros took the decision declare a public health emergency of international concern.

This declaration of a global health emergency is unlikely to result in much change in control activities in the worst-affected countries outside of Africa. However, it may prompt countries that have seen few cases so far to ensure that their health systems are better able to handle if the infection spreads in their country. Hopefully it can also boost funding for research and improving the capacity of endemic countries to manage the disease.The conversation

Paul Hunter is a professor of medicine at University of East Anglia. This article was originally published by The conversation.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ


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