The World Health Organization announced Saturday the spread of monkeypox constitutes a public health emergency of international concern, with “a clear risk of further international spread” as governments around the world rush to contain the growing outbreak.
The designation is the WHO’s highest alert level and has been assigned to six disease outbreaks since being introduced in 2007 including Ebola, Zika, Covid-19 and polio.
WHO chief Tedros Adhanom Ghebreyesus—who in June said he had “serious concerns” but did not consider it an emergency—said he reconvened an emergency committee of experts on Thursday to discuss the escalating outbreak.
The committee did not reach a consensus about whether monkeypox represents a public health emergency of international concern, but Tedros opted to declare one anyway, saying, “in short, we have an outbreak that has spread around the world rapidly.”
Monkeypox has spread for decades in parts of Central and Western Africa where it was largely ignored by the rest of the world. It primarily spreads through close physical contact and generally causes mild disease that goes away on its own, though it can be fatal and can cause agonizing symptoms. It is a close relative of smallpox, one of humanity’s biggest killers and the only human disease eradicated through vaccination, and experts warned the virus could spread globally to fill the void it left behind. On account of its proximity to smallpox, the virus is relatively well understood. Vaccines and treatments to fight smallpox are likely to work against monkeypox and are being used to manage the outbreak. Global supplies are severely limited and data on their use in monkeypox is thin. Similar to the Covid-19 pandemic, wealthy countries like the U.S. moved rapidly to secure available stock but are facing shortages for months until these are delivered and are prioritizing giving out first doses to high-risk groups to stretch resources. Less affluent countries, notably the African nations where the disease has spread for years, are struggling to get a hold of anything.
What To Watch For
Targeted health measures. The overwhelming majority of monkeypox cases around the world have been identified among men who have sex with men, particularly those who have multiple or anonymous sexual partners. The disease is not known to be sexually transmitted—something experts are investigating—but the outbreak is being driven by sexual contact. The federal government expanded the scope of its monkeypox vaccine push in June to recommend those most at risk of catching the disease get vaccinated and are targeting these groups. Public health officials have been careful to avoid language that might stigmatize gay and bisexual men—a harmful and ineffectual public health strategy—but experts have criticized the weak messaging as misleading about who is most at risk of the disease. Tedros said the pattern of transmission “represents both an opportunity to implement targeted public health interventions, and a challenge because in some countries, the communities affected face life-threatening discrimination.”
More than 16,000. That’s how many monkeypox cases have been reported to WHO this year from 75 different countries and territories, Tedros said.
What We Don’t Know
The true extent of the outbreak. The slow rollout of testing and surveillance has hindered the ability to monitor the outbreak in wealthy countries. Testing capacity is generally very limited in poorer nations as well and Tedros said the information provided to WHO from countries in West and Central Africa remains “very scant.” The dearth of information poses a “substantial challenge to designing interventions” to control the outbreak, Tedros added.