Update 7/23/2022 11:00am ET: The World Health Organization on Saturday declared the multinational monkeypox outbreak a public health emergency of international concern (PHEIC), the agency's highest level of alert.
On Thursday, the WHO convened an emergency committee of experts to assess the situation. The committee was unable to reach a consensus on whether to declare a PHEIC, WHO Director-General Tedros Adhanom Ghebreyesus said in a Saturday morning press briefing.
But Tedros, describing himself as a "tie-breaker," noted that under the International Health Regulations he had to consider several elements in deciding whether to declare a PHEIC, in addition to the emergency committee's assessment. Those elements included the scientific unknowns, risks to human health, and risks of further international spread.
"In short," Tedros said, "we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations. For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern."
With the PHEIC declaration, Tedros released a four-tiered set of recommendations for countries. The recommendations deal with issues such as coordinating responses to stop transmission, engaging affected communities, intensifying surveillance, improving infection control in hospitals and clinics, accelerating research into vaccines and therapeutics, and managing international travel.
"We believe that this [PHEIC] will mobilize the world to act together. It needs coordination and it needs ... solidarity," Tedros said. He ended the press briefing by emphasizing that stigma and discrimination can be as dangerous as any virus.
In addition to this development, the US Centers for Disease Control and Prevention on Friday afternoon announced identifying the first two cases of monkeypox in children. One case was in a toddler who lives in California. The other was in an infant who is not a US resident, but was diagnosed in Washington, DC while the family was traveling. Both children are reported to be doing well. Unlike the child's case reported from the Netherlands and described below, the two child cases in the US appear to be explained by transmission from infected household members, who have links to transmission in the men-who-have-sex-with-men community.
Original Story 7/22/2022 1:03pm ET: The World Health Organization is currently reconsidering whether to declare the booming multinational monkeypox outbreak a public health emergency of international concern (PHEIC), the agency's highest level of alert.
The deliberations come as the global tally of monkeypox cases tops 16,000—and a new report of an unexplained case in a child in the Netherlands raises alarm over the potential spread of the virus.On Thursday, the WHO's emergency committee convened for seven hours to assess the state of the outbreak. It was the second time that WHO Director-General Tedros Adhanom Ghebreyesus convened the group of international experts. In the previous meeting nearly a month ago, the committee expressed concern about the situation but concluded overall that it had not yet risen to the level of a PHEIC.
That June decision drew criticism from some members of the public health community, who felt the committee had "punted." Critics further worried the decision undermined the ability of a PHEIC declaration to help get ahead of a burgeoning infectious disease outbreak.
Global cases
The outcome of yesterday's meeting is still unclear. The committee is now finalizing a report to the director-general, and the agency told Ars that there is no set timeline of when the outcome will be announced.
As it stands, WHO received reports of more than 16,000 cases from 71 member states that span all six of WHO-designated world regions. The epicenter of the outbreak continues to be Europe. Five people have died in the multinational outbreak, three in Nigeria and two in the Central African Republic.
Though some countries are starting to report declining trends in cases, Tedros noted, other countries are now just beginning to identify cases. Six countries reported their first cases just last week, he said in a press briefing Wednesday.The vast majority of cases continue to be identified in men who have sex with men (MSM).
"This transmission pattern represents both an opportunity to implement targeted public health interventions and a challenge because in some countries, the communities affected face life-threatening discrimination," Tedros said at the outset of Thursday's emergency committee meeting.
The continued spread of the virus, particularly in countries where people face significant barriers to care, only increases the risk that the virus will spread farther and to more vulnerable populations, such as pregnant people and children, health experts fear.
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