June 26, 2022

expert reaction to WHO Emergency Committee not recommending that the ongoing monkeypox outbreaks be declared a Public Health Emergency of International Concern (PHEIC)

At the International Health Regulations Emergency Committee meeting regarding the multi-country monkeypox outbreak held on the 23rd June, it was recommended that monkeypox should not be declared a Public Health Emergency of International Concern (PHEIC).

Prof Paul Hunter, Professor in Medicine, UEA, said:

“From the notes of the meeting published on the WHO website, it is not clear totally clear how much each of the issues discussed ultimately affected the decision not to declare the current epidemic of Monkeypox a PHEIC. It must be stated it is not WHO that makes this decision one way or another but an independent committee of experts who advise WHO.

“Within the report of the Deliberative session there are some hints of the reasoning behind the committee’s decision of which the following seem to be to have been given prominence.

1. That the epidemic seems to be plateauing or there are downward trends in some (non-endemic) countries affected early in the international epidemic.
2. “… the potential for exacerbation of the stigmatization and infringement of human rights, including the rights to privacy, non-discrimination, physical and mental health, of affected population groups, which would further impede response efforts”.
3. “Additional knowledge gaps and areas of uncertainty, for which more information is needed rapidly to support a more comprehensive assessment of the public health risk of this event, include: transmission modes; full spectrum of clinical presentation; infectious period; reservoir species and potential for reverse zoonoses; the possibility of virus; and access to vaccines and antivirals and their efficacy in humans”.

“In those non-endemic countries with more than 30 cases reported up to 24^th June there is not much evidence to my mind that cases numbers really are plateauing. In any epidemic following a single or small number of events you often see a primary wave of people who contacted their infections at one of these “point sources”. This is then followed by a further wave of secondary infections. Depending on the serial interval and incubation period of the infection these waves may merge into one or give a false appearance that the epidemic may be plateauing or be in retreat. You can see this in the epidemic curve by reporting date (below). So, I think the suggestion of plateauing/decline is being overly optimistic

“I am not sure how declaring Monkeypox a PHEIC would exacerbate stigmatization or infringe human rights.

“Although there are certainly knowledge gaps about Monkeypox and the current epidemic, I do think we know enough to have a pretty good idea of what is driving this epidemic and how it could best be controlled. The recent decision by Canada and the UK to start to offer vaccine to high risk MSM individuals is a very important step in the right direction.

“Ultimately whether a PHEIC was declared or not will not have a huge impact on the current epidemic as those non-epidemic countries with many cases are already taking steps to control the problem in their countries. However, there are two areas where I think it would have helped. Firstly, the drive to increase vaccine manufacture and purchase may be reinforced by a PHEIC. Secondly, such a declaration may help towards improving the flow of support into those African countries that are having a difficult time with endemic Monkeypox such as Democratic Republic of the Congo which has seen Monkeypox kill at least 58 people and infect over 1,200 others since the start of the year https://www.aa.com.tr/en/africa/monkeypox-kills-58-infects-over-1-200-in-dr-congo-since-january-who/2593348

“In any event I suspect that over the next 2 weeks we shall see the overall epidemic outside of Africa continue to grow and possibly accelerate and a PHEIC declared sometime in the next few weeks.”

Professor Gordon Dougan, Director of Infectious Diseases at Wellcome, said: 

“This outbreak is another reminder of our shared vulnerability to infectious disease. Rather than firefighting, we need to work internationally to prevent future infections like Covid and Monkeypox from escalating.  

“Governments do not need to wait for an official declaration to begin acting in a coordinated and measured way. Where cases have been identified, rapid public health responses such as enhanced disease surveillance, contact tracing and self-isolation will be crucial. But with the virus continuing to spread, all countries must step up, integrate their preparations and help those with limited capability.  

“The world must not repeat any mistakes of the past two years. Even though mass vaccination is not recommended, some nations have begun rushing to acquire doses. But while high income countries are now paying attention to this virus, Monkeypox has been affecting people in West and Central Africa for decades. And with new cases now being reported in other low- and middle-income countries, we must ensure that these lifesaving tools are equitably distributed to where they are needed most.  

“If we are to control outbreaks earlier, we need governments, funders, regulators and industry to sustain momentum. This includes establishing clinical trials of the required scale and design for improved Monkeypox vaccines and treatments. 

“The G7 Summit is a test for world leaders. The risk of new infectious diseases emerging and escaping out of control is rising. But by working together and implementing bold reforms, we can transform our global surveillance, research and manufacturing capabilities and deliver tests, treatments and vaccines to those who need them, saving as many lives as possible.” 

https://www.who.int/news/item/25-06-2022-meeting-of-the-international-health-regulations-(2005)-emergency-committee–regarding-the-multi-country-monkeypox-outbreak

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