The World Health Organization has activated the highest level of alert for a growing monkeypox outbreak, declaring the virus a public health emergency of international concern. The rare designation means that the WHO now considers the outbreak to be such a significant threat to global health that a coordinated international response is needed to prevent further spread of the virus and possible escalation into a pandemic.
Although the declaration does not make demands on national governments, it serves as an urgent call to action. WHO can only issue guidelines and recommendations to its member states, not mandates. Member States are required to report events that pose a threat to global health.
The UN agency last month refused to declare a global emergency in response to monkeypox. But infections have increased substantially over the past few weeks, prompting WHO Director-General Tedros Adhanom Ghebreyesus to issue the highest warning.
Before declaring a global health emergency, a WHO emergency committee meets to consider the evidence and make recommendations to the Director-General. The committee was unable to reach a consensus on whether monkeypox constituted an emergency. Tedros, as head of the WHO, decided to issue the highest alert based on the rapid spread of the epidemic around the world.
“We have an outbreak that has spread rapidly around the world through new modes of transmission that we understand too little about,” Tedros said. “For all these reasons, I have decided that the worldwide epidemic of monkeypox constitutes a public health threat of international concern.”
So far this year, more than 16,000 cases of monkeypox have been reported in more than 70 countries, and the number of confirmed infections rose by 77% from late June to early July, according to WHO data. Men who have sex with men are currently at the highest risk of infection. Five deaths from the virus have been reported in Africa this year. No deaths have yet been reported outside of Africa.
Most people recover from monkeypox in two to four weeks, according to the US Centers for Disease Control and Prevention. The virus causes a rash that can spread over the body. People who have contracted the virus have reported that the rash, which looks like pimples or blisters, can be very painful.
The current monkeypox epidemic is very unusual because it is spreading widely in North American and European countries where the virus is not usually found. Historically, monkeypox spread at a low level in remote parts of West and Central Africa, where the virus was carried by rodents and other animals.
Europe is currently the global epicenter of the epidemic, accounting for more than 80% of confirmed infections worldwide in 2022. The United States has so far reported more than 2,500 cases of monkeypox in 44 states, Washington, D.C. and Puerto Rico. Tedros said the risk posed by monkeypox is moderate worldwide, but the risk is high in Europe. There is clearly a risk that the virus will continue to spread around the world, he said, although it is unlikely to disrupt global trade or travel right now.
In early May, the United Kingdom reported a case of monkeypox in a person who had recently returned from a trip to Nigeria. A few days later, the United Kingdom reported three more cases of monkeypox in humans, apparently contracted locally. Other European countries, Canada and the USA then also started to confirm cases. It is not clear where the epidemic actually began.
The WHO last declared a global health emergency in January 2020 in response to the Covid-19 outbreak and declared it a pandemic two months later. The WHO has no official process for declaring a pandemic under its organizational laws, meaning the term is loosely defined. In 2020, the agency declared Covid a pandemic in an effort to warn complacent governments of the “alarming level of spread and severity” of the virus.
The WHO’s leading expert on monkeypox, Dr Rosamund Lewis, told reporters in May that the UN health agency was not concerned that monkeypox would cause a global pandemic. She said public health authorities had an opportunity to stop the outbreak. But infectious disease experts worry that health authorities have failed to stop the epidemic, and monkeypox has taken permanent root in countries where the virus had not previously been found, except in isolated travel-related cases.
Monkeypox is not a new virus
Unlike Covid-19, monkeypox is not a new virus. Scientists first discovered monkeypox in 1958 in captive monkeys used for research in Denmark and confirmed the first human case of the virus in 1970 in the country of Zaire, now called the Democratic Republic of the Congo.
Monkeypox belongs to the same virus family as smallpox, although it causes a milder illness. WHO and national health agencies have decades of experience fighting smallpox, which was declared eradicated in 1980. The successful fight against smallpox and the tools developed against it will provide health officials with important knowledge in the fight against monkeypox.
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