WHO to convene panel to determine whether mpox outbreak is a public health emergency

The director general of the World Health Organization announced Wednesday that he will convene a panel of experts to advise him on whether the expanding outbreak of mpox in sub-Saharan Africa constitutes a global health emergency.

The outbreak, which began in the Democratic Republic of the Congo but has spread recently to at least three other neighboring countries, has involved more than 14,000 reported cases so far this year alone, Tedros Adhanom Ghebreyesus said, with at least 511 deaths reported.

While the DRC has long reported outbreaks of mpox, the size and dynamics of this one represents something new, Tedros suggested. “The number of cases reported in the first six months of this year match the number reported in all of last year, and the virus has spread to previously unaffected provinces [of DRC],” he said.

Members of the so-called emergency committee will be named “as soon as possible,” the director general said. Regardless of what it advises, the final decision on whether the outbreak is declared a public health emergency of international concern — a PHEIC — rests with Tedros. In July 2022, in an earlier mpox outbreak, he declared a PHEIC despite the fact that an emergency committee he had convened could not come to a consensus that one was needed. That public health emergency was declared over in May 2023.

Under the provisions of the International Health Regulations, a PHEIC can be declared if a disease event represents something that is unusual and serious, has a potential for international spread, and is likely to require international cooperation to achieve containment.

Mpox is caused by a virus in the same family as smallpox, a virus that was declared eradicated in 1980. The virus, which is carried by small rodents in some countries in Africa, causes painful blistering rashes that leave scars when contracted by people. In addition to the rash, people with mpox can experience fever, muscle aches, headaches, and respiratory symptoms. Infection is especially dangerous in young children and people with compromised immune systems.

The earlier outbreak was first detected in May of 2022, when health authorities in the United Kingdom reported cases of mpox among gay, bisexual, and other men who have sex with men who had not traveled abroad before becoming infected. By the time the PHEIC was declared over, 111 countries had reported more than 87,000 confirmed and 1,100 probable cases of mpox, 140 of which had ended in death. The United States reported the highest number of cases in that outbreak, more than 32,000, with at least 58 deaths.

Though that global health emergency was declared over, the spread of mpox was not stopped. There continue to be cases associated with that outbreak reported, both in countries that were involved in the initial outbreak, and in new countries. The WHO estimated that by the end of June there had been nearly 100,000 confirmed cases in 116 countries, 208 of them fatal.

The current outbreak involves a different version of the mpox virus than was responsible for that earlier event. This version of the virus, known as clade I, has historically been associated with a higher fatality rate than the virus that caused the earlier outbreak, clade IIb.

To date no cases associated with this outbreak have been detected outside of central and eastern Africa. But the Centers for Disease Control and Prevention, which has been monitoring the outbreak closely, warned doctors on Wednesday that they should be on the lookout for cases, especially if they see patients who have recently been in the DRC or in countries that border it — the Republic of the Congo, Angola, Zambia, Rwanda, Burundi, Uganda, South Sudan, or the Central African Republic — and who have symptoms consistent with mpox.

Rosamund Lewis, the WHO’s point person for mpox, said that in the DRC, the case fatality rate for clade I infections is 3.6%, but she noted the rate of death varies considerably, depending on the age of the person infected. Young children are more likely to die from mpox, for instance.

Lewis and Maria Van Kerkhove, WHO’s acting director of epidemic and pandemic preparedness and prevention, explained that the outbreak in the DRC involves both cases that fit the traditional pattern of mpox infections — children, particularly in rural areas where there virus is endemic, becoming infected after trapping infected rodents and triggering some resulting spread in their households — and transmission via sexual networks. Though it had been suspected for some time that some mpox spread was happening through sex, the 2022 outbreak was the first time this mode of transmission was confirmed.

Clade I mpox viruses had not previously been confirmed to spread this way, but it is now clear from the data collected by health authorities in the DRC that sexual spread is fueling this event, Lewis said. Early in the outbreak, a substantial portion of cases were among sex workers and their clients, but that portion of cases has declined as the virus has spread out into other portions of the population. A new variant of the clade I virus, which has been dubbed clade Ib, is responsible for the person-to-person spread. It shows signs that the virus is evolving to adapt to transmission in humans, a pattern that also occurred with the 2022 outbreak involving clade II viruses.

Cases have been detected in Burundi, Rwanda, Kenya, and Uganda, with the latter three already linked to the DRC outbreak. Analysis of the virus discovered in Burundi is still underway, Tedros said.

He suggested affected countries need financial assistance and vaccines, noting that the WHO has already released $1 million from its emergencies fund. On Wednesday, USAID announced it is committing an additional $10 million to help the DRC and other affected countries in the region battle the outbreak. The United States is also donating 50,000 mpox vaccines.

Tedros noted that the WHO has already issued emergency use listings — the agency’s equivalent of the emergency use authorizations that the Food and Drug Administration uses — for two brands of mpox vaccine. This process makes it easier for countries that do not have their own robust regulatory agencies to use the vaccines.