WHO expected to raise monkeypox to pandemic status

In a decision which could prove pivotal to the global response to the virus, the World Health Organisation (WHO) was expected to declare today (24 June) whether monkeypox should be categorised as an international emergency.

The WHO’s International Health Regulations Emergency Committee met on Thursday this week to discuss whether the monkeypox outbreak should be labelled a Public Health Emergency of International Concern (PHEIC) a designation which would be hugely significant as it would mobilise new funding and, it is hoped, spur governments into greater action to combat the spread of the virus. 

COVID-19 was given the PHEIC designation following a similar meeting in January 2020.

“The emergency committee and then the [WHO] director general’s announcement will raise the political level of this,” David Heymann, a professor of infectious-disease epidemiology at the London School of Hygiene and Tropical Medicine who attended the meeting, was reported as saying in advance of the official announcement.

The emergency committee meeting on Thursday included experts from the most affected regions, who have also consulted with scientists. 

They have made a recommendation to WHO Director-General Tedros Adhanom Ghebreyesus, who makes the ultimate decision on whether to call the emergency.

The step mainly functions to sound the alarm, and can prompt further guidance from the WHO, as well as focus attention among member states. 

The WHO has already provided detailed guidance on the outbreak and said it is working on a mechanism for sharing treatments and vaccines.

Most experts agree monkeypox technically meets the criteria for the WHO definition of an emergency, given that it is a sudden and unusual event spreading internationally, and requires cross-country cooperation.

Surge in cases

The expected decision from the UN agency comes as cases continue to surge in Europe, with the UK particularly affected.

The UK, where almost 800 cases of the virus have been recorded in the past month, has the highest reported number of infections outside of Central and West Africa, and case trends are worrying experts throughout Europe.

Indeed, monkeypox cases rose almost 40% in the UK in under five days, according to data shared by the UK Health Security Agency. As of 16 June, 574 cases had been recorded, and by 20 June, the number had risen to 793.

After the UK, Spain, Germany and Portugal have the most recorded cases, while the virus is also a growing threat outside of Europe. More than 3,200 cases have been confirmed across 48 nations in the past six weeks, according to the WHO, which publishes data on monkeypox in weekly intervals. 

So far, the response in most European countries has been to focus on outreach to at-risk communities, contact tracing and isolation for known monkeypox cases. This response may change if the WHO, which first raised the alarm about monkeypox infections in countries where the virus is not endemic in May, increases the threat level of the outbreak.

Sexual transmission

Monkeypox is spread through close contact and has so far primarily affected men who have sex with men. It begins with flu-like symptoms before fluid-filled lumps or lesions appear on the skin, which can leave behind permanent scarring. 

Health officials say that the latest outbreak has frequently brought genital rashes, and while most cases are mild and patients recover in three weeks, the virus can be fatal and is more of a risk to pregnant people or those with weakened immune systems.

To contain the outbreak, a broader understanding of its origins along with vaccination of at-risk groups and contact tracing is imperative, experts say, although they note some patients may not want to divulge information about who they have been intimate with, a factor which can complicate the public health response.

The UK has sought to track people with known cases of monkeypox and in some cases, distributed smallpox vaccines, which are known to protect against monkeypox infection, to their close contacts and at-risk groups.

The UK, where almost 800 cases of the virus have been recorded in the past month, has the highest reported number of infections outside of Central and West Africa, and case trends are worrying experts throughout Europe.

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