The impact of monkeypox on global health

The WHO considers that, at the moment, monkeypox does not constitute an international emergency.

Specifically, the Emergency Committee of the World Health Organization (WHO) considers that the monkeypox outbreak does not constitute, for now, a public health emergency of international concern.

Experts from the Emergency Committee advise against issuing the highest level of health alert, but express great concern about the scale and speed of the current outbreak and point to many unknowns and gaps in the current data.

After a three-day meeting, the Committee resolved by consensus to advise the Director General of the Organization not to declare the highest level of alert according to international health regulations, although “some members expressed different opinions”.

So far, monkeypox has been detected in 50 countries, from all regions, with 3,000 cases since the beginning of May.

However, the Committee unanimously recognizes that the outbreak constitutes an emergency and that controlling it will require an “intense” response. Experts advise monitoring the situation closely and reviewing it after a few weeks, once more information about the current unknowns becomes available, to determine if there have been any significant changes that might warrant reconsidering the decision.

“The Emergency Committee shared their deep concern about the scale and speed of the current outbreak, pointed out many unknowns and gaps in the current data, and prepared a consensus report reflecting the different views of the committee,” said Dr. Tedros Adhanom Gebreyesus, the Director General of the Organization in a statement “They told me that at this time the event does not constitute a public health emergency of international concern, which is the highest level of alert that the WHO can issue, but they recognized that the call of the committee itself reflects growing concern about the international spread of monkeypox.”

Tedros added that the WHO is “very closely” following the evaluation of the disease. “What makes the current outbreak especially concerning is the continued rapid spread to new countries and regions, and the risk of sustained new transmission in vulnerable populations, such as immunocompromised people, pregnant women and children,” he explained. .

Monkeypox virus, in an image captured under a microscope. (Photo: CDC)

Unusual aspects and knowledge gaps

The Committee notes that many aspects of the current multinational monkeypox virus outbreak are unusual, such as the occurrence of cases in countries where circulation had not previously been documented, and the fact that the vast majority of cases were observe among young men who have sex with men, not previously immunized against smallpox (knowing that smallpox vaccination is effective in protecting against monkeypox as well).

Some members suggested that, given the low level of population immunity against smallpox virus infection, there is a risk of transmission in the general population that should not be overlooked. The Committee also notes that monkeypox virus activity has been neglected and poorly controlled for years in African countries.

Other knowledge gaps and areas of uncertainty, on which more information is needed to support a more complete public health risk assessment of this event, are: modes of transmission; the full spectrum of clinical presentation; the infectious period; reservoir species and the potential for reverse zoonosis; and access to vaccines and antivirals and their efficacy in humans.

The monkeypox virus is most often spread through direct contact with the rash or sores of someone who has the virus. It can also spread through contact with clothing, bedding, and other items used by a person with the illness, or by respiratory droplets that can be transmitted through prolonged face-to-face contact. The risk of aerosol transmission is not yet fully understood. The WHO recommends that health workers caring for monkeypox patients wear a mask.

Symptoms usually begin 7 to 14 days after exposure, but in some cases may not appear until 21 days. The most common symptom is a rash or sores on the skin. Flu-like symptoms such as fever, swollen lymph nodes, headache, and tiredness may also occur. In some cases, monkeypox can cause severe illness.

The UN agency does not recommend mass vaccination against monkeypox. In the few places where vaccines are available, they are being used to protect those who may be exposed, such as health workers and laboratory personnel.

Factors to reconsider the decision

The Committee explains a number of factors that should prompt a reassessment of the situation:

-Increase in the rate of growth of cases reported in the following 21 days;

-Appearance of cases among sex workers;

-Significant spread in additional countries or significant increases in the number of cases and spread in endemic countries;

-Increase in the number of cases in vulnerable groups, such as immunosuppressed people, pregnant women and children;

-Increased severity of reported cases (ie increased morbidity or mortality and hospitalization rates);

-Tests of reverse propagation to the animal population;

-Significant changes in the viral genome leading to increased transmissibility, virulence or immune escape properties, or resistance to antivirals;

-Cases associated with clades of greater virulence detected in new countries outside West and Central Africa.

Outbreak Response

The Committee insists that the response to the outbreak “requires collaborative international efforts.”

The experts are concerned about the possibility that the stigmatization and the violation of the rights of the affected groups will worsen, “which would make the response even more difficult.” Additionally, some Committee members said that laws and practices that criminalize or stigmatize same-sex sex “create barriers to accessing health services and may also hamper response interventions.”

The WHO says it is “urgent” for all Member States, communities and individuals to adopt the committee’s recommendations to intensify surveillance, improve diagnosis, community engagement and risk communication, and the appropriate use of drugs. treatments, vaccines and public health measures, including contact tracing and isolation.

Since the monkeypox outbreak became known on May 7, the WHO has issued clinical guidance and has called on hundreds of scientists and researchers to speed up the investigation. It has also met with members of the LGBTQI+ community and organizations so that health information and advice on protective measures is shared effectively around mass gatherings. (Font: UN News)