For the time being in two years, the World Health Organization has taken the ordinary resolution to call for a global emergency. This time, the cause is monkeypox, which has spread in a few weeks to dozens of countries and inflamed tens of thousands of people.
DR Tedros Adhanom Ghebreyesus, the WHO director-general, on Saturday reversed the resolution of an advisory panel, which may not succeed in consensus, and declared a “public health emergency of foreign interest”, a designation the WHO uses to describe only two other diseases, COVID-19 and polio.
“We have an epidemic that has spread rapidly around the world thanks to new modes of transmission, of which we perceive very little and which meets the criteria” of a public fitness emergency, Tedros told reporters. This is said to have been the first time the Director-General had stepped away from his advisers to claim an emergency.
WHO identifies a public health threat that requires a coordinated foreign response. The designation can lead member countries to invest significant resources to control an outbreak, get more budget for the response, and inspire countries to percentages of vaccines, remedies and other key resources to engage outbreaks.
This is the seventh public fitness emergency since 2007; the COVID pandemic, of course, the recent maxim. Some global fitness experts have criticized the WHO criteria for pointing out such opaque and inconsistent emergencies.
At an assembly in June, WHO advisers concluded that while monkeypox is a developing threat, it is not a foreign emergency. The panel may simply not take a resolution on Thursday, Tedros said.
“This procedure demonstrates once again that this important tool wants to be subtle to make it more effective,” he added, referring to the WHO’s deliberations.
Monkeypox has been a fear for years in some African countries, however, in recent weeks the virus has spread around the world. Some 75 countries have reported at least 16,000 cases to date, about five times the number when WHO advisers met in June.
Almost all infections outside of Africa have occurred in men who have sex with men. The epidemic has galvanized many members of the LGBT community, who have accused apepox of not getting the attention it deserves, as happened at the beginning of the HIV epidemic. .
The WHO is “better behind schedule than ever,” said Dr. Boghuma Titanji, an infectious disease physician at Emory University in Atlanta. But with the delay, “it can be said that the reaction at the global point has continued to suffer from a lack of coordination with individual countries that operate at very different rates to solve the problem.
“There is almost capitulation that we prevented the monkeypox virus from being built more permanently. “
Dr. James Lawler, co-director of the University of Nebraska’s Global Center for Health Security, estimated the outbreak could take a year or more. By then, the virus will most likely have inflamed thousands more people. and possibly had taken root permanently in some countries.
“Sadly, we’ve now missed the train so we can end the epidemic before,” Lawler said. “Now it’s going to be a genuine struggle to be able to get involved and control the spread. “
The longer the epidemic continues, the more likely it is that the virus will pass from other inflamed people to animal populations, where it can persist and sporadically cause new infections in humans. It is a way for a disease to become endemic in a region. .
As of Saturday, the United States had recorded nearly 3,000 cases, in addition to two children, but the actual number would be much higher, as testing alone is now intensifying. Britain and Spain have almost the same number of cases, and the rest are spread out. in about 70 countries.
Many other inflamed people in those countries report that there is no known source of infection, indicating an undetected network spread.
WHO advisers said in late June they would not recommend an emergency declaration in part because the disease had not left the most threatening group, men who have sex with men, pregnant women, the young or the elderly, who are at higher risk of serious illness if infected.
Although the virus is spread primarily by close contact, researchers are still evaluating transmission routes in the existing outbreak. And in interviews, some experts said they disagreed with the justification.
“Do you need to claim an emergency at the time when things go wrong, or should you do it in advance?”Isabella Eckerle, clinical expert on viruses at the University of Geneva.
“We don’t have this challenge anymore. We don’t see the virus in children. We don’t see it in pregnant women,” she added. But we know that if we let it go and don’t do enough, it will take place at some point. “
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A WHO committee that met in early 2020 to assess the coronavirus outbreak also met twice and decided only at its meeting at the time, on January 30, that the spread of the virus constituted a public health emergency.
Committee members advised at the time that WHO create “an intermediate alert level” for outbreaks of moderate concern. The organization would possibly want such a formula as outbreaks become more frequent.
Deforestation, globalization and climate substitution are creating more opportunities for pathogens to move from animals to humans. Today, an emerging virus can temporarily cross national borders and become a global threat.
But the maximum public health government remains stocked to control chronic diseases or small outbreaks.
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The devastation of the COVID pandemic and the monkeypox outbreak serve as a warning to governments to prepare for new outbreaks without warning, said Tom Inglesby, director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.
“Although the world is tired of infectious disease crises, they are part of a new general that will require a lot of attention and ongoing resources,” he said. “We want global approaches to the production and storage of vaccines and therapeutics that do not yet exist. “
Monkeypox has erupted periodically in some African countries for decades. Experts have been sounding the alarm about its potential global risk for years, but their warnings have generally been ignored.
Vaccines and drugs are obtained largely because of fears of a bioterrorist 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 of supply, which has delayed the remedy for days or even weeks for some patients.
Doses of Jynneos, the latest and safest of the two vaccines available, have been serious, including in the United States, which helped expand the vaccine.
As of Friday, New York City had recorded 839 cases of monkeypox, nearly all in men who have sex with men, according to the city’s Department of Health. of about 1,000 doses available.
The source has slowly increased since then to about 20,000 doses. The city submitted 17,000 appointments for the first dose on Friday night, but they also filled up quickly.
“The source of vaccines remains weak,” the city’s fitness department said Saturday.
Containing the virus can be even more difficult in countries where the source of vaccines and medicines is limited or non-existent. Without the framework of a global emergency, each country will have to find its own way to obtain tests, vaccines and remedies, exacerbating inequalities between nations.
The lack of coordination of the reaction has also squandered opportunities to gather knowledge in giant multinational studies, especially when disease surveillance tends to be uneven.
“This inability to characterize the epidemiological scenario in this region represents a significant challenge in designing interventions to control this traditionally overlooked disease,” Tedros said of West and Central African countries on Thursday.
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For example, cases of monkeypox in Nigeria and Congo, where the virus is endemic, suggest that a painful rash throughout the body can spread within a week or two of exposure.
But many patients of the existing epidemic have developed lesions only in the genital area. Some, especially those who expand sores in the throat, urethra, or rectum, have suffered excruciating pain.
“I was actually afraid to use the bathroom,” said a recent patient, Gabriel Morales, 27, a part-time model who lives in New York. “I can’t even describe it. It looks like damaged glass.
Many other patients experienced only mild symptoms and some did not have fever, body aches or respiratory symptoms related to the disease.
It’s conceivable that severe cases have only been detected in endemic areas of Africa, and the existing outbreak gives a more accurate picture of the disease, Eckerle said. Or it may be that the virus itself has significantly replaced, as has the profile of the symptoms it provokes.
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Based on initial genetic analyses of samples from inflamed patients, the monkeypox genome appears to have picked up just about 50 mutations since 2018, more than the six or seven it should have accumulated that period.
It is not known whether the mutations replaced the mode of transmission, severity, or other characteristics of the virus. But early analyses suggest that monkeypox likely would have adapted to spread more easily among other people than before 2018.
Coordinating the reaction among nations would help many of the uncertainties surrounding the outbreak, Eckerle said: “There are so many open questions. “