Why declaring monkeypox a global health emergency is a preventative step — not a reason for panic

of International Health Regulations are a set of rules that guide how WHO and United Nations member states respond to emerging health threats.

Under current regulations, a “public health emergency of international concern” – often abbreviated as PHEIC – may be declared by the Director General of WHO when three criteria are met: the situation is an “extraordinary event”, there is a risk of spreading to other countries and the situation may “potentially require a coordinated international response”.

Before monkeypox, only five diseases had been designated as PHEICs since the WHO began using the term in 2005: the H1N1 influenza pandemic in 2009; the re-emergence of polio in Afghanistan, Nigeria and Pakistan in 2014; the Ebola epidemic in Guinea, Liberia and Sierra Leone in 2014 and an Ebola outbreak in the Democratic Republic of Congo in 2019; the spread of the Zika virus in the Americas in 2016; and the coronavirus pandemic in 2020. While all of these events were important, only the coronavirus pandemic became a worldwide catastrophe.

Why is monkeypox a public health emergency of international concern?

The WHO Director-General is the only person who can declare a PHEIC, but the decision is based on the advice of the designated emergency committee. After the monkeypox emergency committee met for the second time on July 21, 2022, it issued a report stating that “the outbreak of monkeypox in many countries meets all three criteria that define a PHEIC.”

The rapid spread of the virus in more than 70 countries was evidence of the risk of further international spread. The committee expressed concerns about whether vaccines would be reasonably priced and distributed equitably in the absence of a coordinated international response. And agreed there were aspects of the situation that were “extraordinary” – a vague term that is not defined in the International Health Regulations.

However, the committee did not unanimously agree that a public health emergency of international concern should be declared. Some members asked whether a disease that has a low mortality rate should be PHEIC. Others worried that a PHEIC designation could further stigmatize LGBTQ communities since most cases so far have been diagnosed among men who have sex with men.

of the vote by the emergency committee was split – nine against and six for PHEIC status. But Director-General Tedros decided to go ahead and declare monkeypox a PHEIC.

What happens now?

of purpose of a PHEIC designation is to prevent an emerging disease from becoming a global health crisis. WHO has two initial goals for monkeypox. First, to try to stop the virus from circulating in susceptible populations where it is not currently present. And second, to distribute vaccines and antiviral medications to the countries and communities that need them most.

Following PHEIC’s statement, WHO issued a set of interim recommendations which calls on countries to do more to prevent cases in affected and at-risk communities, to improve clinical care for people with monkeypox, and to contribute to research into vaccines and treatments for monkeypox. The recommendations also require countries to advise infected individuals and their direct contacts not to travel except in emergency situations, but they do not place any restrictions on international travel or trade.

Finally, the WHO has advised that individuals who are members of at-risk communities take steps to protect themselves from the virus, but has not called for behavioral change in the general public.

A public health emergency of international concern is the highest level of alert in the International Health Regulations, but is not synonymous with a pandemic. The status is a means of protecting the health of the global population and not a declaration that a global crisis is already occurring.

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