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WHO declares monkeypox a global health emergency


For the second time in two years, the World Health Organization has taken the extraordinary step of declaring a global emergency. This time the cause was monkeypox, which spread in just a few weeks to dozens of countries and infected tens of thousands of people.

Dr Tedros Adhanom Ghebreyesus, director general of the WHO, on Saturday passed an advisory panel who could not come to a consensus, and declared a “public health emergency of international concern. heart”, a designation that WHO currently uses only to describe two diseases, Covid-19 and polio.

“We have an outbreak that has spread rapidly around the world through new modes of transmission that we understand so little about and meet the criteria for,” Dr Tedros told reporters. Apparently this is the first time the general manager has evaded his advisers to declare an emergency.

The WHO statement signals a public health risk that requires a coordinated international response. This designation could lead Member States to invest significant resources in controlling an outbreak, attract additional funding for the response, and encourage countries to share vaccines and treatments. and other important resources to contain outbreaks.

This is the seventh public health emergency since 2007; The Covid pandemic, of course, is the most recent. Some global health experts have criticized the WHO criteria for declaring such emergencies like opaque and inconsistent.

At a meeting in June, WHO advisers concluded that although monkeypox was a growing threat, it was not yet an international emergency. The council could not make a decision on Thursday, Dr Tedros said.

“This process proves once again that this important tool needs to be honed to make it more effective,” he added.

Monkeypox has been a concern for many years in some African countries, but in recent weeks the virus has spread worldwide. About 75 countries have reported at least 16,000 cases so far, nearly five times the number when WHO advisers met in June.

Nearly all infections outside of Africa occur in men who have sex with men. The outbreak has caused many in the LGBT community who have charge monkey pox have not received the attention it’s worth it, as happened in the early days of the HIV pandemic.

The WHO statement is “better late than never,” said Dr Boghuma Titanji, an infectious disease physician at Emory University in Atlanta.

But given the delay, “one could argue that the global response continues to fall short of coordination with individual countries working at very different speeds to address the issue.”

She added: “It’s almost a surrender that we can’t stop the monkeypox virus from forming on its own any longer.

Dr. James Lawler, co-director of the University of Nebraska’s Center for Global Health Security, estimates that it could take a year or more to bring the outbreak under control. By then, this virus has likely infected hundreds of thousands of people and may be permanent in some countries.

Dr Lawler said: “Unfortunately, we have now really missed the boat that could have covered up the outbreak earlier. “Now it will be a real struggle to be able to contain and control the spread.”

The longer the outbreak lasts, the greater the chance that the virus will move from infected people to animal populations where it can persist and frequently cause new human infections. This is one of the ways that a disease can become endemic in an area.

As of Saturday, the US had recorded nearly 3,000 cases, including two children, but the true number is thought to be much higher, as testing is currently only being expanded. About how many cases are in the UK and Spain each, and the rest are distributed across about 70 countries.

Many of those infected in these countries reported unidentified sources of infection, indicating undetected community spread.

WHO advisers said at the end of June that they were not recommending an emergency declaration in part because the disease has not yet moved out of the main risk group of men who have sex with men, affecting women. pregnant women, children or the elderly, who are more at risk of becoming seriously ill if they become infected.

Although the virus spreads primarily through close contact, researchers are still evaluating transmission routes during the current outbreak. And in interviews, several experts said they disagreed with the rationale.

“Do you want to announce the emergency as soon as it gets really bad, or do you want to do it first?” Isabella Eckerle, a clinical virologist at the University of Geneva.

“We don’t have this problem now. We don’t see the virus in children, we don’t see it in pregnant women,” she added. “But we knew if we let this go, and we didn’t do enough, it was going to happen at some point.”

A similar WHO committee that convened in early 2020 to assess the coronavirus outbreak also met twice, deciding only at its second meeting on January 30 that the spread of the virus became public health emergency.

Committee member recommended at the time which WHO considers creating an “intermediate alert level” for moderate outbreaks. The organization may need such a system as outbreaks become more frequent.

Deforestation, globalization and climate change are creating many opportunities for pathogens to jump from animals to humans. Now, an emerging virus can quickly cross national boundaries to become a global threat.

But most public health agencies are still only equipped to handle chronic illnesses or small outbreaks.

Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, said the devastation of the Covid pandemic and the rise of smallpox in monkeys should serve as a warning to policymakers. Government prepares for new epidemics without notice.

“As the world grows weary of infectious disease crises, they are part of a new normal that requires a lot of ongoing care and resources,” he said. “We need global methods of producing and stockpiling vaccines and therapeutics that do not yet exist.”

Monkeypox has had periodic outbreaks in several African countries for decades. Experts have been sounding the alarm about its potential as a global threat for years now, but their warnings have gone largely unheeded.

Vaccines and drugs are available largely because of fears of a bioterrorism attack with smallpox, a close relative of the monkeypox virus.

But access to a drug called tecovirimat has been hampered by time-consuming bureaucracy and government control over its supply, delaying treatment by days or even days. weeks for some patients.

The dose of Jynneos, the newer and safer of the two vaccines currently available, has been severe restriction – even in the United States, which helped develop a vaccine.

As of Friday, New York City had recorded 839 cases of monkeypox, nearly all of which occurred in men who had sex with men, according to the city’s Department of Health. At the end of June, the city begins provide smallpox vaccine to monkeysbut ran out with only about 1,000 doses available.

Supply has increased slowly since then to about 20,000 doses. The city offered an additional 17,000 first-dose appointments Friday night, but those also quickly filled up.

“Vaccine supply is still low”, city health department website said on Saturday.

Containment of the virus may be even more difficult in countries with limited or no supplies of vaccines and treatments. Without the framework of a global emergency, each country must find a way to provide its own tests, vaccines and treatments, exacerbating inequalities between countries.

Failure to coordinate the response has also wasted data collection opportunities in large multinational studies, especially where disease surveillance tends to be slow.

“The inability to describe the epidemiological situation in that area presents a significant challenge to the design of interventions to control this historically neglected disease,” said Dr. Tedros. statement on Thursday.

For example, cases of monkeypox in Nigeria and the Democratic Republic of the Congo, where the virus is endemic, suggest that a painful rash all over the body can develop one to two weeks after contact.

But many patients in the current outbreak have developed lesions only in the genital area. Some – especially those with sores in the throat, urethra, or rectum – experience severe pain.

“I was really scared to use the bathroom,” said one recent patient, Gabriel Morales, 27, a part-time model based in New York City. “I can’t even describe it. It feels like broken glass.”

Many other patients have only mild symptoms, and some do not have the fever, body aches, or respiratory symptoms commonly associated with the disease.

It is possible that only severe cases have been detected in endemic areas of Africa, and the current outbreak provides a more accurate picture of the disease, Dr. Eckerle said. Or it could be The virus itself has changed dramaticallyas well as a profile of the symptoms it causes.

Based on preliminary genetic analysis Among samples from infected patients, the monkeypox genome appears to have collected nearly 50 mutations since 2018, more than the six or seven that are expected to accumulate. in that period.

It is unclear whether the mutations change the mode of transmission, severity, or other qualities of the virus. But early analysis suggests that monkeypox may have adapted to spread between humans more easily than it did before 2018.

Coordinating the response across countries will help resolve many of the uncertainties surrounding the outbreak, Dr. Eckerle said: “There are a lot of open questions.”

Joseph Goldstein and Sharon Otterman contribution report.



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