After the World Health Organization (WHO) Emergency Committee failed to reach a consensus, the WHO Director-General Tedros Adhanom Ghebreyesus declared the global monkeypox outbreak a public health emergency of international concern to spur the public health community to mitigate its spread.

When the outbreak began in May 2022, the WHO was tracking 3,040 cases in 47 countries. As of the emergency committee’s meeting on 23 July 2022, it is tracking 16,000 reported cases from 75 countries and territories with five deaths.

“The majority of reported cases of monkeypox currently are in males, and most of these cases occur among males who identified themselves as gay, bisexual, and other men who have sex with men, in urban areas, and are clustered in social and sexual networks,” the WHO explained. “Early reports of children affected include a few with no known epidemiological link to other cases. There has also been a significant rise in the number of cases in countries in West and Central Africa, with an apparent difference in the demographic profile maintained than that observed in Europe and the Americas, with more women and children amongst the cases.”

After a briefing by representatives from countries with confirmed monkeypox cases, Ghebreyesus then weighed five elements in considering whether the outbreak meets the threshold to be a public health emergency of international concern. These included reports from countries experiencing cases of monkeypox for the first time, the advice of the emergency committee, scientific principles, and the risk to human health, international spread, and the potential for interference with international traffic.

"WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region where we assess the risk as high,” Ghebreysus said in a statement. “So in short, 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 tools we have right now, we can stop #monkeypox transmission and bring this outbreak under control. It’s essential that all countries work closely with affected communities to adopt measures that protect their health, human rights and dignity.pic.twitter.com/DqyvRtB8w2

— Tedros Adhanom Ghebreyesus (@DrTedros) July 23, 2022

To escalate the response to monkeypox, Ghebreysus made recommendations for countries with no history of the virus in humans that have not detected a case in 21 days, countries with recently reported monkeypox cases in humans that might also be experiencing human-to-human transmission, and countries with known or suspected zoonotic transmission of monkeypox or who have reported it in the past.

Depending on each country’s status, recommendations varied and included basic public health suggestions to create mechanisms to respond to monkeypox cases, engage key community-based groups to spread accurate information about monkeypox, isolate known cases, and increasing manufacturing capacity for smallpox and monkeypox diagnostics, vaccines, and therapeutics.

The WHO acknowledged that isolating cases and conducting contact tracing for monkeypox could help bring the outbreak under control, but implementing these practices is “extremely challenging,” in part because of barriers to testing and the ongoing COVID-19 pandemic.

With the right mitigation strategies, however, WHO Director-General Ghebreysus remained optimistic that it can be stopped. He stressed the need to work closely with communities of men who have sex with men to design and deliver effective information and services, along with adopting measures that protect health, human rights, and dignities of those affected.

“Stigma and discrimination can be as dangerous as any virus,” he said in a statement. “In addition to our recommendations to countries, I am also calling on civil society organizations, including those with experience in working with people living with HIV, to work with us on fighting stigma and discrimination. But with the tools we have right now, we can stop transmission and bring this outbreak under control.”

Monkeypox Basics

Monkeypox is a communicable disease, but it is not similar to the novel coronavirus that caused the COVID-19 pandemic. According to a New York Times explainer article, the disease was first discovered in primates in 1958, and first diagnosed in a human in 1970 in the Democratic Republic of Congo. Human cases of monkeypox generally result from close contact with an infected animal—typically a rodent of some kind, despite the name of the disease.

Since 1970, there have been small outbreaks of human-to-human transmission, mostly limited to a few hundred cases in Africa, which have occasionally spread to other countries due to travel. The current outbreak is the largest number of confirmed cases outside of Africa, according to an explainer article from our previous coverage on the outbreak. 

Cases Around the World

At the emergency committee meeting, members were briefed by representatives from Canada, Nigeria, Spain, the United Kingdom, and the United States. Except for Nigeria’s representative, all others confirmed that 99 percent of cases were occurring in men who had sex with men, particularly those who had multiple partners. 

“Nigeria recorded a little over 800 cases of monkeypox between September 2017 and 10 July 2022 and has seen [a] 3 percent case fatality ratio among confirmed cases,” the WHO said in a press release. “Cases are predominantly in men aged 31 to 40 years; there was no evidence of sexual transmission presented. The highest number of annually reported cases since 2017 has been observed in 2022.”

The European Union reported at least 7,665 cases, according to Civio, with Spain (2,895), Germany (1,859), France (912), The Netherlands (549), and Portugal (515) reporting the highest number of cases. Elsewhere in Europe, the United Kingdom has reported 1,856 cases. 

In Canada, which has more than 680 cases, health advocates and medical experts said the country might not have enough supply of the monkeypox vaccine to meet demand. Health officials have administered more than 20,000 vaccine doses so far in Ontario and Quebec where 90 percent of confirmed cases have been reported.

“We did have excellent uptake, right at the start of the vaccine rollout in May and June, but we need to continue to scale it up,” said Dr. Darrell Tan, an infectious disease specialist at St. Michael’s Hospital in Toronto, Ontario, in an interview with CBC.

In the United States, monkeypox cases are distributed across the country with just a few confirmed cases in children and a pregnant woman. The U.S. Centers for Disease Control and Preparedness (CDC) is tracking 2,891 confirmed cases (as of 22 July 2022), with three areas having the highest number of cases (New York, 900; California, 356; and Florida, 247). 

Given its spread across the country, U.S. health officials are concerned that monkeypox could become an endemic sexually transmitted disease and that federal officials have not acted quickly enough to contain the outbreak. 

“Had federal officials shown a strong will to action, more could have been done to stop the spread just using basic public health,” said California Assembly Speaker Anthony Rendon, calling on federal officials on 20 July to declare monkeypox a national public health emergency in a report from The Los Angeles Times. “During recent Pride Month activities, thousands of those vaccine doses could have been administered at celebratory events, clinics, LGBTQ bars, and gathering places throughout the state. That did not happen, and it enabled the spread.”