The start of the new monkeypox outbreak will be 2 months old next week, since the first cases were detected in the United Kingdom on May 6. The world already has more than 3,500 cases in more than 50 countries and several genetic branches of the virus have already been detected.
Despite all this, the World Health Organization (WHO) has not yet classified this situation as a public health emergency of international concern, something that draws attention, more after the mistaken experience it has had in delaying the declaration of a pandemic for COVID-19 more than two years ago.
WHO officials have communicated this week that the global spread of monkeypox does not yet warrant declaring the outbreak an emergency. of public health of international interest (PHEIC). The decision, announced on June 25, was made after two days of deliberation after an internal emergency committee of the world health entity.
The spread of the viral disease has caused alarm as many of the affected countries had not seen sustained transmission of monkeypox until this year. Although the WHO decided not to declare monkeypox as PHEIC, the highest level of alert the organization can do, “recognized that the convening of the committee itself reflects a growing concern by the international spread of monkeypox”, explained the director general of the WHO, Tedros Adhanom Ghebreyesus.
The Committee unanimously recognized 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 organization would review the decision if the outbreak grew in global scope or severity.
“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 that reflects the different opinions of the committee. They advised me that at this time the event does not constitute a public health emergency of international concern, which is the highest level of alert the WHO can issue, but acknowledged that the committee’s own convening reflects growing concern about the international spread of monkey pox”Dr. Tedros said.
Tedros added that The WHO follows “very closely” 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.like the immunosuppressed people, pregnant women and children”, he explained.
What constitutes a PHEIC?
Refusing to classify the outbreak as PHEIC surprised some global health experts who said the WHO seemed to conclude in its final report that monkeypox had met all three necessary criteria. An outbreak is considered PHEIC when it is extraordinary, with a significant risk of international spread and could require a coordinated response to control it.
“The criteria for a PHEIC appear to have been met, but have not yet been declared. There is something else at stake, we just don’t know what that is,” said Dr. Clare Wenham, associate professor of global health policy at the London School of Economics. The decision to label a health threat as PHEIC is ultimately made by an independent committee of experts advising the WHO. But Paul Hunterprofessor of medicine at University of East Angliasaid the organization’s report left some clues as to why it may have decided not to raise the threat level.
It may be because the WHO concluded that transmission rates are declining in non-endemic countries, that declaring a PHEIC could cause stigmatization and human rights violations in the affected groups, or that understanding of the public health risk of monkeypox remains too incomplete, Hunter said. Alexandra Phelanglobal health attorney Georgetown University, he said the decision not to classify monkeypox as PHEIC raised the question of whether the alternative would have been an uncomfortable admission that the perceived level of threat of an outbreak depended largely on the wealth of the affected nations. This virus has been circulating in several African countries for decades, but has only received international concern and media coverage after it spread to Europe and several countries around the world this year. “It is unfair and unethical to determine that an event is only extraordinary if it is now taking place in high-income countries,” Phelan told Science.
The sustained spread of monkeypox in many countries that had previously seen only isolated cases of the virus, often linked to travel from Africa or animal trafficking, has baffled epidemiologists and virologists. In the UK, which accounts for around a third of cases in the current global outbreak, 99% of cases have been reported in men and mostly from networks of men who have sex with men. Some outbreaks have been linked to individual “superspreading” events that may have fueled an initial surge in cases.
A study led by researchers in Portugal and published in Natural Medicine found that the virus has acquired more mutations than expected. A mutation of the virus is one theory as to why it is spreading to new countries when it had previously vanished. Germany is currently experiencing the most sustained growth in monkeypox virus transmission rates in Europe, with the country now reporting almost 50 new infections per day. In England, where most of the UK’s monkeypox cases have been detected, 1,035 cases were reported as of June 26, 162 more than two days earlier. A PHEIC declaration obliges WHO member countries to follow its health recommendations. Polio and COVID-19 are currently considered by the WHO as PHEIC.
“Governments do not need to wait for an official declaration to start acting in a coordinated and measured manner. When cases have been identified, rapid public health responses, such as better surveillance of the disease, will be crucial. contact tracing and self-isolation. But as the virus continues to spread, all countries must step up, integrate their preparations and help those with limited capacity,” he said. Gordon Dougan, director of infectious diseases at Wellcome.
“I suspect that over the next couple of weeks we will see the overall epidemic outside of Africa continue to grow and possibly accelerate and declare a PHEIC sometime in the next few weeks,” Hunter added.
In the meantime, European Union countries with the highest infection rates this week began receiving their first doses of a smallpox vaccine. Spain, which has the next highest number of recorded cases globally after the UK, will receive 5,300 doses of Bavarian Nordic’s Imvanex vaccine on June 28, followed by Belgium, Germany and Portugal.
Measures have also been taken in the US. The White House announced on June 28 that it will begin shipping tens of thousands of doses of vaccine to clinics across the country. in an effort to control the outbreak. As of November 29, there have been 306 cases and no deaths recorded in the US.
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