A World Health Organization emergency committee will meet Thursday to decide whether the monkeypox outbreak constitutes a public health emergency of international concern (PHEIC), a major test for the agency after it was widely criticized for how it handled the early stages of the Covid-19 pandemic.
World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus during a press … [+] conference in 2018.
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A PHEIC is the WHO’s highest alert level under international law and is declared by the Director-General on the advice of an expert committee.
The purpose is to raise public awareness and sound the alarm for governments to take steps to contain an outbreak, as well as provide guidance on what measures they should take to do so.
In deciding whether the monkeypox outbreak merits a PHEIC designation, the group will assess it against three criteria: if it is serious, sudden, unusual or unexpected, if it has potential for international spread and if it requires a coordinated global response.
Experts tell Forbes they believe the monkeypox outbreak very likely satisfies all three criteria—something echoed by other experts online—though they note it is not a foregone conclusion that WHO chief Dr. Tedros Adhanom Ghebreyesus will declare a PHEIC.
There is an element of subjectivity to the decision, Clare Wenham, an associate professor of global health policy at the London School of Economics and Political Science, told Forbes, noting past decisions where other factors have played a role.
What To Watch For
The committee’s recommendation and the WHO’s response. The meeting is held behind closed doors and the decision is set to be communicated “in the days following the meeting.” If it declares monkeypox a PHEIC, the committee will also make recommendations on what guidance the WHO can issue to countries to help contain the outbreak.
What We Don’t Know
What will happen if the monkeypox outbreak is declared a PHEIC. Under international law, nations are expected to take steps to address a PHEIC, though they are not compelled to act. There is scarce empirical evidence on what happens if a PHEIC is declared or if one is not declared, Wenham said, and also no guarantee countries will heed the agency’s warning. When the WHO sounded the alarm over the spread of a novel coronavirus—the virus that causes Covid-19—in January 2020, there was a delay of nearly two months until countries began to take substantive action against the pandemic. A monkeypox PHEIC would mark a “test” for the WHO’s authority after Covid, said Wenham. “If they do declare a PHEIC, it will be interesting to see if countries pay attention,” she added.
Years after declaring the spread of a novel coronavirus a PHEIC, the WHO lamented the fact that the world only seemed to sit up and pay attention when Tedros described the situation as a “pandemic” in March 2020. There is no legal declaration for a pandemic, however, it is just a descriptive epidemiological term used to describe the scale of an infectious disease outbreak, Alexandra Phelan, an assistant professor at the center for global health science and security at Georgetown University, told Forbes. “The whole point of a PHEIC is that it should happen well before a pandemic,” Phelan added. “The idea is that it puts countries on alert to prevent one.”
Monkeypox is a well known disease that has circulated in some parts of Africa for decades. It is a close relative of smallpox, one of humanity’s biggest killers and the only human disease eradicated through vaccination, which means treatments and vaccines are available and effective, though not necessarily widely available. With some notable exceptions, most known cases of monkeypox outside of Africa prior to the current outbreak have been linked to travel in the region, and the discovery of the virus spreading in Europe and North America in May alarmed scientists and public health officials. Experts say the fact the virus appeared at the same time in many different countries suggests it may have been quietly circulating for some time, possibly years.
That the virus has caused disease in parts of Africa for decades but only garnered significant global attention—or talk of an emergency—following outbreaks in wealthier nations in Europe and North America has sparked criticism from African scientists and officials, who fear a repeat of the stark inequalities in accessing vital supplies during the Covid-19 pandemic. Experts have also called out the problematic rhetoric from many commentators and media outlets linking the virus to Africa and the WHO is pushing for the virus to “minimize the negative impact.” The organization also no longer makes the distinction between cases in endemic countries where the virus typically circulates and other countries outside these regions. As the majority of cases outside Africa have been reported among men who identify as gay, bisexual or have sex with men, there has also been a flurry of homophobic rhetoric. Experts warn stigma will make it harder to contain the disease and does not reflect the fact that the virus will infect anyone, regardless of sexuality. Monkeypox does not spread easily between people and is primarily transmitted through close contact with an infected animal or person or objects contaminated by someone with an infection like towels, clothes or bedding. Less commonly, the virus also spreads through respiratory droplets produced when people breathe, cough, talk or sneeze and experts are exploring the possibility of sexual transmission after the virus was detected in the semen of some patients.