WHO has called the latest mpox outbreak an ‘emergency of international concern’

WHO has called the latest mpox outbreak an ‘emergency of international concern’

Subject: Science and Tech

Sec: Health

Context:

The World Health Organisation, sounding its highest level of alarm, declared mpox as a Public Health Emergency of International Concern (PHEIC). This is the second time the infection has received the designation in as many years — the outbreak between July 2022 and May 2023 was also declared as PHEIC. The decision to sound the alarm was taken after an upsurge of cases reported from the Democratic Republic of Congo (DRC) and neighbouring countries.

Mpox (monkeypox):

• It is a viral zoonotic disease caused by the monkeypox virus.
• The first human case of mpox was recorded in 1970 in the Democratic Republic of the Congo (DRC).
• There are two known types (clades) of mpox virus — one that originated in Central Africa (Clade I) and one that originated in West Africa (Clade II). 
• Symptoms: Common symptoms of mpox are a skin rash or mucosal lesions, which can last 2–4 weeks accompanied by fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
• Transmission: Human-to-human transmission of mpox occurs through direct contact with body fluids, lesions, prolonged face-to-face contact, including sexual contact, and indirect contact with contaminated clothing or bedding. 
• Treatment: There are no specific treatments for monkeypox virus infection.Early and supportive care is important to help manage symptoms and avoid further problems.

Current concern around Mpox:

• The current concern stems from the spread of clade Ib of the MPXV, which is predominantly transmitted through sexual contact.
• Organisms belonging to a clade share common ancestors. When it comes to mpox, there are two different clades: clade I and clade II, with the former deadlier than the latter.
• Historically, clade I infections have spread through zoonotic spillover events — transmitted from animals to humans in close proximity.
• Clade Ia infections that spread this way continue to affect parts of DRC where the disease was endemic.
• Now, over 100 cases of clade 1b infections have been reported in four countries neighbouring DRC — Burundi, Kenya, Rwanda and Uganda — that have not reported mpox before.

Vaccines for mpox:

• There are at least two vaccines currently in use for mpox, which have been recommended by the WHO’s Strategic Advisory Group of Experts on Immunization.
• Last week, an Emergency Use Listing for mpox vaccines was triggered by the WHO, which will accelerate vaccine access for lower-income countries which have not yet issued their own national regulatory approval.
• This listing also enables bodies such as GAVI and UNICEF to procure vaccines for distribution in these countries.

International Health Regulations

About:

• While disease outbreaks and other acute public health risks are often unpredictable and require a range of responses, the International Health Regulations (2005) (IHR) provide an overarching legal framework that defines countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders.
• The IHR are an instrument of international law that is legally-binding on 196 countries, including the 194 WHO Member States. The IHR grew out of the response to deadly epidemics that once overran Europe.
• They create rights and obligations for countries, including the requirement to report public health events. The Regulations also outline the criteria to determine whether or not a particular event constitutes a “public health emergency of international concern”. 
• At the same time, the IHR require countries to designate a National IHR Focal Point for communications with WHO, to establish and maintain core capacities for surveillance and response, including at designated points of entry.
• Additional provisions address the areas of international travel and transport such as the health documents required for international traffic.
• Finally, the IHR introduce important safeguards to protect the rights of travellers and other persons in relation to the treatment of personal data, informed consent and non-discrimination in the application of health measures under the Regulations.

How does IHR Emergency Committee work?

The Emergency Committee is made up of international experts who provide technical advice to the WHO Director-General in the context of a “public health emergency of international concern” (PHEIC) The Committee provides views on:

• whether the event constitutes a public health emergency of international concern (PHEIC);
• the Temporary Recommendations that should be taken by the country experiencing an emergency of international concern, or by other countries, to prevent or reduce the international spread of disease and avoid unnecessary interference with international trade and travel; and
• the termination of a PHEIC.

The Director-General makes the final determination of a PHEIC and Temporary Recommendations to address the situation, based on advice from the Emergency Committee, information provided by the State Parties, scientific experts and an assessment of risk to human health, risk of international spread of disease and of risk of interference with international travel.

Under the IHR (2005), Temporary Recommendations automatically expire three months after their issuance. Emergency Committees are therefore reconvened at least every 3 months to review the current epidemiological situation and to review whether the event continues to be a public health emergency of international concern and whether changes need to be made to the Temporary Recommendations. A statement of the Emergency Committee meeting is published on the WHO website after each meeting of the Committee.

What is Public Health Emergency of International Concern (PHEIC)?

A PHEIC is defined in the IHR (2005) as, “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is:

• serious, sudden, unusual or unexpected;
• carries implications for public health beyond the affected State’s national border; and
• may require immediate international action.