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WHO readies monkeypox emergency reponses

The U.N. health agency is seeking global access to vaccines against monkeypox and calling a meeting to decide if the virus outbreak is a global emergency.

A digitally-colorized electron microscope image shows monkeypox virions
A digitally-colorized electron microscope image shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 U.S. prairie dog outbreak (AN/Cynthia S. Goldsmith, Russell Regnery)

GENEVA (AN) — Prompted by the COVID-19 pandemic's inequities, the U.N. health agency is developing a new "mechanism" to provide global access to vaccines that are effective against monkeypox and calling an emergency meeting for next week to decide how to handle its mysterious spread to 34 nations beyond the parts of Africa where it is endemic.

"The magnitude of this outbreak poses a real risk; the longer the virus circulates, the more it will extend its reach, and the stronger the disease’s foothold will get in non-endemic countries," the World Health Organization’s Europe director, Dr. Hans Kluge, told reporters on Wednesday. "Governments, health partners and civil society need to act with urgency, and together, to control this outbreak."

Kluge said he worries about wealthy countries hoarding vaccines once again without ensuring supplies for Africa.

"But what about those countries in Africa where monkeypox has long been endemic — should they not be part of any global strategy to address the disease?" he asked. "Once again, a 'me first' approach could lead to damaging consequences down the road, if we do not employ a genuinely collaborative and far-thinking approach. I beseech governments to tackle monkeypox without repeating the mistakes of the pandemic  — and keeping equity at the heart of all we do."

WHO does not recommend mass vaccination against the virus, which has mushroomed to more than 1,800 confirmed new cases just since early May. It has now been found in about three dozen countries, including more than 30 where it isn't usually detected. The new cases are mainly concentrated among gay and bisexual men in Western Europe and North America.

Smallpox vaccines are thought to be about 85% effective against monkeypox, WHO says, and one vaccine against monkeypox exists but it is only approved for use in Canada and the United States.

Decisions about the costs and benefits of using smallpox vaccines against monkeypox should be made on a case-by-case basis due to limited clinical data and supplies, WHO Director-General Tedros Adhanom Ghebreyesus told reporters on Tuesday.

"It’s also essential that vaccines are available equitably wherever needed," he said. "To that end, WHO is working closely with our member states and partners to develop a mechanism for fair access to vaccines and treatments."

Such a mechanism could wind up helping the mainly wealthy countries where many of the new cases are occurring, however, though there also has been a rise in cases in Africa.

Before the recent oubreak, the monkeypox virus — endemic in the African countries of Benin, Cameroon, Central African Republic, Congo, Congo Republic, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, Sierra Leone and South Sudan — was mainly seen as just another neglected tropical disease.

Tedros announced WHO is working with partners and experts to rename the monkeypox virus, its clades and the disease it causes, after a group of international scientists, with the backing of the Africa Centers for Disease Control and Prevention, posted a letter complaining "the nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatizing."

Worried about stigma and racism, the scientists say "the most obvious manifestation of this is the use of photos of African patients to depict the pox lesions in mainstream media in the Global North" and cite a statement by Foreign Press Association Africa urging journalists to stop using images of Africans to illustrate the outbreak in Europe.

Researchers are finding "growing evidence that the most likely scenario is that cross-continent, cryptic human transmission has been ongoing for longer than previously thought," the scientists say. "We therefore believe that a nomenclature that is neutral, non-discriminatory and non-stigmitizing will be more appropriate for the global health community."

Learning about monkeypox

Now that it has spread to nations such as Britain, Canada, France, Germany, and the U.S., WHO says it will convene an emergency committee of experts to decide if the monkeypox outbreak outside Africa is a global health emergency.

Monkeypox spreads through close contact and causes flu-like symptoms and skin lesions. It is considered fatal in about 3-6% of cases, WHO says. Most of this year's deaths have occurred in Congo.

"The global outbreak of monkeypox is clearly unusual and concerning," said Tedros. "It’s for that reason that I have decided to convene the Emergency Committee under the International Health Regulations next week, to assess whether this outbreak represents a public health emergency of international concern."

WHO officials say the risk of monkeypox is not limited to men who have sex with men, and that anyone who has close contact with someone who is infectious is at risk. "However, given that the virus is being identified in these communities, learning about monkeypox will help ensure that as few people as possible are affected and that the outbreak can be stopped," WHO advised.

The WHO emergency committee has the power to issue the highest level warning about the outbreak, a designation that typically fast-tracks more international research and action. It would be the third such real-time threat. The two others are the COVID-19 pandemic and the international spread of poliovirus, each of which was classified as "a public health emergency of international concern" in January 2020 and May 2014, respectively.

Vaccine inequity across the globe has emerged as a major theme. After the outbreak of coronavirus was declared a pandemic in March 2020, more than 30 nations pledged to help 10 international organizations raise US$35 billion for fast-tracking coronavirus tests, medicines and vaccines.

Despite its promises of fair and equitable access to vaccines for all, the COVAX program, co-led by WHO, Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations, could not overcome the stockpiling among wealthy nations of the bulk of the world's supplies.

By mid-2021, only 1% of the population of low-income countries had been vaccinated. Tedros set a goal of vaccinating 70% of the world’s population against COVID-19 by mid-2022, but he said last month just 57 countries had vaccinated 70% of their population, almost all of them high-income countries.