The World Health Organization declared the monkeypox outbreak a public health emergency of international concern, the health body’s highest level of alert.
The decision on Saturday from WHO chief Tedros Adhanom Ghebereyesus came as the organization's emergency committee was unable to reach consensus on whether the outbreak constituted such a global emergency.
"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 Regulations," said Tedros.
The emergency committee was split with nine members against declaring the outbreak a global public health emergency of international concern and six in favor, Tedros said.
"Nine and six is very, very close. But at the same time there was no consensus," Tedros said. "Of course, since the role of the committee is to advise, I then had to act as a tie-breaker."
The latest figures show that more than 16,000 cases of monkeypox have been reported to the WHO during the outbreak, which has left health officials scrambling to secure vaccine doses. The European Commission has secured over 160,000 jabs for the disease, with EU Health Commissioner Stella Kyriakides saying this week that she was concerned about the increasing number of cases, which had risen by almost 50 percent in the EU in a week.
On Friday, the European Medicines Agency recommended that the smallpox vaccine Imvanex’s license be extended to cover monkeypox. Bavarian Nordic’s vaccine was granted approval to prevent smallpox in 2013, with the EMA’s recommendation paving the way for more widespread rollout of the vaccine in the EU.
Monkeypox is endemic to several African countries and is transmitted between humans through close contact with an infected person. However, the current global outbreak has raised fears about the virus establishing itself outside the continent. “Monkeypox is spinning out of control & could become endemic outside of Africa,” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law, tweeted on Friday.
The monkeypox virus usually presents with a fever, rash and swollen lymph nodes. The current global outbreak is unusual as it's occurring in multiple countries without travel links to areas where the virus is endemic. Anyone can be infected with monkeypox but during the current outbreak, cases have been mostly identified in men who have sex with men, with infections being transmitted through close contact during sex.
The head of the WHO’s health emergencies program, Mike Ryan, called for countries to take the monkeypox outbreak seriously, regardless of who it affects. He also warned that the declaration shouldn’t be used as a way to implement coercive surveillance on groups most affected by the virus.
Tedros has made a set of recommendations for countries depending on how the outbreak is developing in their regions. The recommendations include intensifying surveillance and public health measures; speeding up research into the use of vaccines and treatments; and advice on international travel.
The report of the emergency committee that failed to reach consensus was also released on Saturday, revealing the key reasons for several experts being against the declaration of an international public health emergency. The reasons included the global risk assessment remaining unchanged; the greatest burden of the outbreak being in Europe and the Americas with early signs of a stabilization of cases in some places; most cases being in men who have sex with men; and the severity of the disease being low.
While many global health experts welcomed Tedros’s decision to take the unusual step of declaring an emergency in the face of differing advice from the scientists advising him, the fact that the virus has spread in Africa for decades without significant attention also has been highlighted. “With monkeypox cases continuing to rise and spread to more countries, we now face a dual challenge: an endemic disease in Africa that has been neglected for decades, and a novel outbreak affecting marginalized communities,” said Josie Golding, head of epidemics and epidemiology at Wellcome Trust. “Governments must take this more seriously and work together internationally to bring this outbreak under control.”
Jimmy Whitworth, emeritus professor at the London School of Hygiene and Tropical Medicine, said he hoped that the increased attention on monkeypox “leads to more focus on control within Africa, the natural home of this virus, where the number of cases has been increasing for the past 20 years.”
As with COVID-19 vaccines, African countries have found themselves at the back of the queue for monkeypox jabs, with the head of the WHO’s Africa office, Matshidiso Moeti, previously warning that wealthy countries were snapping up limited supplies, while Africa was left behind.