This weekend, the World Health Organization (WHO) designated the ongoing multicountry monkeypox outbreak a public health emergency of international concern (PHEIC), sparking renewed pledges from U.S. public health leaders to ramp up vaccination and other response measures.
A PHEIC is the highest level alert at WHO’s disposal. The designation does not come with any specific mandates for WHO member countries, but the global organization does issue temporary recommendations and encourage collaborative efforts between member states.
WHO’s International Health Regulations committee had previously met to discuss issuing the designation in late June but had concluded that the outbreak did not yet warrant a PHEIC.
Reports of monkeypox cases have since escalated from 3,040 cases among 47 countries to more than 16,800 cases in 74 countries. In the U.S., reports grew from roughly 200 cases to just under 2,900, including the first cases reported among children.
Monkeypox spreads through close personal contact. The overwhelming majority of reported cases have been among gay men and are suspected to have been the result of sexual activity with another infected person, according to recent data published in The New England Journal of Medicine.
WHO’s committee was divided in both meetings on whether the outbreak warranted the top alert. Dissenters this past week pointed to the disease’s low severity, no signs of exponential case increases in the hardest-hit countries and the potential risk of a PHEIC designation increasing stigma against LGBTI+ communities that would subsequently hamper response efforts.
Unlike at last month’s divided meeting, WHO Director-General Tedros Ghebreyesus decided the time was right to declare monkeypox a PHEIC.
"For the moment, this monkeypox outbreak is concentrated among men who have sex with men, especially those with multiple sexual partners. That means that this is an outbreak that can be stopped with the right strategies in the right groups,” Ghebreyesus said in a Twitter post announcing the decision and linking to WHO’s recommendations.
In the U.S., public health officials said Friday that the federal government has so far shipped over 300,000 doses of monkeypox vaccine across the country. They also said the administration is looking to streamline provider prescriptions of tecovirimat, an antiviral treatment that is currently only approved for smallpox, and prioritize research on reducing vaccination to a single dose in order to preserve limited supply.
However, the weekend’s announcement from WHO kicked off new promises from federal leaders to accelerate domestic and international responses.
U.S. Department of Health and Human Services Secretary Xavier Becerra and White House Pandemic Preparedness Office Director Raj Panjabi, M.D., each released statements describing WHO’s designation as “a call to action” for health entities around the world to coordinate an international response to the outbreak.
Speaking Sunday on CBS’ "Face the Nation," White House COVID-19 response coordinator Ashish Jha, M.D., said he and the administration believe monkeypox “can be contained” in the U.S. The country now has the capacity to conduct 80,000 diagnostic tests a week and recently imported 800,000 vaccine doses that will be distributed “in the upcoming couple of weeks,” he said.
HHS is also weighing whether to declare a public health emergency for monkeypox in order to free up additional resources, Jha confirmed in media appearances over the course of the weekend.
Those conversations are "ongoing", Jha said during a Friday press conference, although so far the administration is confident it can rein in the outbreak without the need for a declaration.
“We're going to continue to look at all sort of policy options,” he said Sunday on "Face the Nation." “Right now, we think we can get our arms around this thing, but obviously, if we need further tools, we will invoke them as we need them.”
Syra Madad, an epidemiologist and senior director of the systemwide special pathogens program at New York City Health + Hospitals, applauded WHO's PHEIC designation and the Biden administration's commitment to a stronger response but lamented that both groups could have acted more quickly in order to contain the virus's spread.
She said that although the administration's specific measures and announced research goals will likely be effective in preventing wider spread, there also needs to be more support for those stuck at home due to a suspected or confirmed monkeypox infection.
"There’s no wrap-around services we’re providing to individuals who have to isolate for up to three weeks if they have monkeypox," Madad, who is also a fellow at the Harvard University's Belfer Center for Science and International Affairs, told Fierce Healthcare. "If we’ve learned anything from COVID, people have been balking at five days of isolation, 10 days of isolation, let alone three weeks. We have to be doing more on supporting people to help isolate."
Although the case counter moving is moving upward and vaccine doses are still in short supply, Madad said she doesn't expect the monkeypox pandemic to reach the level of the ongoing COVID-19 pandemic.
Still, she advised providers and health systems that haven't seen monkeypox patients to begin hashing out a game plan.
"Know what the signs and symptoms of monkeypox are, know how to screen these patients, know how to isolate them, know how to treat individuals and make sure your providers are educated on monkeypox because it is, obviously, an exotic disease that healthcare providers in the U.S. haven’t seen before," she said. "Now that we’re dealing with a large outbreak, it’s very likely that they may start seeing cases."