January 27, 2023

The designation doesn’t force new actions from countries to tackle the virus, but it sounds the alarm to address the threat posed by the outbreaks – even as Covid-19 and polio remain active international public health emergencies .

“WHO’s assessment is that the risk of monkeypox is moderate worldwide, except in the European region, where we assess the risk to be high,” said WHO Director-General Tedros Adhanom Ghebreyesus in his announcement. “With the tools we have now, we can stop the transmission and get this outbreak under control.”

The WHO called a meeting a month ago to determine whether monkeypox was a PHEIC, but then decided it wasn’t, despite some advisers disagreeing with the call. At that time, there were about 3,300 cases worldwide, with 150 in the US

Now more than 16,800 cases have been reported worldwide, with nearly 2,900 in the US

Still, many questions remain unanswered, including why so many new infections are being reported in countries where the virus is not endemic. Those cases have already led to increased demand for vaccines and therapies that can be used to stop the spread and treat those already infected.

The WHO’s decision comes despite its emergency committee unable to reach a consensus on whether the virus constitutes an international health emergency. But the statement adds a new international urgency to the already rushed efforts to get supplies to handle business.

“We’re in kind of a paradoxical situation with monkeypox,” Piero Olliaro, a University of Oxford researcher who advised WHO members on monkeypox research priorities, told POLITICO in an email on Wednesday. “On the one hand, our knowledge of the clinical presentation and outcomes of monkeypox in the western world is improving, and we may even have one or more treatments and a vaccine, on the other hand, we still have little evidence to support which intervention should be used. and how to break the transfer chains and how to manage business effectively.”

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Looking for vaccines and therapies

Also unlike Covid-19, vaccines and therapies that can be used for monkeypox already exist – although many are approved for smallpox and face regulatory barriers to full approval.

Jynneos, a third-generation smallpox vaccine that is also approved for monkeypox in some countries, has so far been seen as the best choice to tackle the outbreaks, despite relatively few doses being available worldwide. The US has shipped more than 300,000 doses of the vaccine, with millions more on the way — to help fill the gaps in states and cities. And countries have done the same, with European countries ordering well over a million doses earlier this month.

In its initial guidelines, the WHO listed two other vaccine options for possible use in monkeypox patients. Another third-generation vaccine is currently held only in Japan, although WHO is talking to the country to expand access, Rosamund Lewis, WHO technical chief for monkey pox, told POLITICO in an earlier interview.

The third vaccine on the list – ACAM2000 – is available in much larger quantities. The US has about 100 million doses of the second-generation vaccine in its reserves, although it has not been formally approved in the US for monkeypox except as a new investigational drug.

And the battle for resources goes beyond vaccines to antivirals. Tecovirimat, an orthopox antiviral that shows promise for the treatment of monkeypox, is relatively scarce around the world. Siga, the small company that makes Tecovirimat, is talking to dozens of countries about ordering the drug — and appears to be ramping up its production capacity.

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Beyond the declaration

Declaring monkeypox a public health emergency of international concern is unlikely to change what countries are doing to control the virus. Orders for vaccines and therapies, along with extensive testing and public messages, will continue.

Before Saturday’s announcement, U.S. officials discussed how to improve their own response, including declaring a national public health emergency and exploring ways to better distribute limited doses across a large population.

Global health equity is a critique of the early responses to monkeypox – as it has been during the pandemic – with few endemic countries having access to the countermeasures that are now more widely used.