For the second time in just over 2 years the World Health Organization (WHO) is ringing its loudest alarm bell about the same disease: mpox.
This afternoon, WHO Director-General Tedros Adhanom Ghebreyesus announced that, after a meeting earlier in the day, an emergency committee had advised him to declare ongoing outbreaks of the viral illness a Public Health Emergency of International Concern (PHEIC).
The move, sparked by rapid spread in four African countries that have never had mpox cases before, comes on the heels of yesterday’s decision by the Africa Centres for Disease Control and Prevention (Africa CDC) to declare the first ever Public Health Emergency of Continental Security. The actions together are “historic,” says Lawrence Gostin, an expert on global health law at Georgetown University. “It is the first time that both a regional and global health emergency have been declared.”
The WHO declaration will make “a huge difference,” predicts Nicaise Ndembi, who coordinates the mpox response at Africa CDC, because it will unlock resources and push countries to coordinate the fight against the virus.
First diagnosed in people in 1970 in the Democratic Republic of the Congo (DRC), mpox has sporadically jumped from wildlife hosts to humans for decades, without sustained spread between people. But outbreaks have steadily grown in size, and two recent, separate developments have raised alarm.
One is a new variant of the virus, named clade IIb, that started to spread around the world in May 2022, infecting nearly 100,000 people, the vast majority men who have sex with men (MSM). WHO declared a PHEIC in July 2022 and ended it in May 2023 after the number of new cases had gone down significantly, thanks in part to vaccination in MSM communities.
This year, another new variant, named clade Ib, was detected in the eastern DRC. It has caused several thousand cases there, in part because of sexual transmission, and has recently spread to Rwanda, Burundi, Uganda, and Kenya, none of which have seen mpox before. Those facts, combined with “the potential for further spread within Africa and beyond is very worrying,” Tedros said at a press briefing today. He also pointed out that clade IIb is still spreading globally, although not as fast as 2 years ago. “It’s clear that a coordinated international response is essential to stop these outbreaks and save lives,” Tedros said.
Anne Rimoin, an epidemiologist at the University of California, Los Angeles who long has collaborated on mpox studies with colleagues in the DRC, says she is glad to see swift action from both WHO and Africa CDC: “We know that this virus can move quickly and have hopefully learned lessons from the global outbreak that emerged in 2022.”
The mere announcement that WHO was convening an emergency committee today had already spurred some action, says Alexandra Phelan, a global health law expert at Johns Hopkins University, pointing to a decision by the European Union today to donate 215,000 doses of mpox vaccine to Africa CDC. “While that is a drop in the ocean of the 10 million vaccines the Africa CDC says are needed, it shows that this process serves as an important alert to the international community,” Phelan says.
But the repeat of the global declaration also shows that the termination of the first PHEIC in 2023 was “premature,” Phelan contends, particularly given the fact that countries in the Global North had “failed to appropriately respond to the ongoing efforts needed.”
WHO has declared a PHEIC seven times before, but this is the first time since the International Health Regulations (IHRs)—a global treaty that established the tool—was updated in May, Gostin notes. The changes in IHRs call for “solidarity and equity” to help all countries access appropriate medicines and financing to respond to health emergencies.
Although the modified regulations only take effect next year, they need to guide the spirit of the mpox response, Gostin says. “We can’t be formalistic and legalist in waiting for equity until 2025. It needs to happen now.”
