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  • The World Health Organisation declared on Saturday (July 23, 2022) the monkeypox outbreak as a “Public Health Emergency of International Concern” (PHEIC), the UN health body’s highest alert level. 
  • As of July 23, 2022, monkeypox has affected nearly 17,000 people in 74 countries, according to a tally.
  • The World Health Network (WHN), an independent group of renowned scientists, has earlier declared monkeypox a “pandemic”. 

Monkeypox has hit another world record in number of daily cases reported across the world. This marks its fast spread and potential as a mass-disabling illness, say experts.

More than 16,800 people had been infected with monkeypox in 74 countries, according to a tally by the US Centers for Disease Control and Prevention (CDC) published on Friday (July 22).

WHO triggers highest alert on monkeypox

The monkeypox outbreak is now a public health emergency of international concern (PHEIC), the head of the World Health Organisation has declared Saturday (July 23) — overruling a divided expert panel to issue the agency’s highest alert.

The move paves the way for stepped-up global surveillance and cooperation to stop the virus’ spread. 

The last time the WHO made a similar declaration was during the early stages of the COVID-19 outbreak in January 2020.

More on Monkeypox

"I have decided that the global monkeypox outbreak represents a public health emergency of international concern," WHO chief Tedros Adhanom Ghebreyesus said at a press conference Saturday.

He said a committee of experts who met on Thursday was unable to reach a consensus — so it fell to him to decide whether to trigger the highest alert possible.

"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," he added.

Fresh outbreak

Europe is currently the global epicenter of the outbreak, reporting more than 80% of confirmed infections worldwide in 2022. The US has reported more than 2,500 monkeypox cases so far across 44 states, Washington, D.C., and Puerto Rico.

Potential vaccine

On June 23, the WHO convened an emergency committee of experts to decide if monkeypox constitutes a so-called Public Health Emergency of International Concern - the UN health agency's highest alert level.

But a majority advised Tedros that the situation, at that point, had not met the threshold.

The second meeting was called on Thursday with case numbers rising further, where Tedros said he was worried.

"I need your advice in assessing the immediate and mid-term public health implications," Tedros told the meeting, which lasted more than six hours.

A viral infection resembling smallpox and first detected in humans in 1970, monkeypox is less dangerous and contagious than smallpox, which was eradicated in 1980.


New data from the European Centre for Disease Prevention and Control and the World Health Organization European regional office shows the monkeypox outbreak in Europe has grown to 4,177 cases in less than 2 months, with the United Kingdom producing 25% of those cases.

Germany has surpassed Spain and Portugal with a national total reaching 838 cases, compared to 736 cases in Spain and 365 in Portugal. France has 350 cases.

Meanwhile, cases were also confirmed in two Asian countries — Thailand and India — earlier this week.

Is Monkeypox airborne?

In 2019, health authorities at Nigeria’s Centre for Disease Control (CDC) issued the "National Monkeypox Public Health Response Guidelines”, published by the Federal Ministry of Health — stating monkeypox can also “spread by air”.

What is an “outbreak”?
According to WHO’s definition, confirmation of one case of monkeypox, in a country, is considered an outbreak. The agency explained the disease may have been transmitted earlier than thought.

“The unexpected appearance of monkeypox in several regions in the initial absence of epidemiological links to areas that have historically reported monkeypox, suggests that there may have been undetected transmission for some time.”

WHO advice on gatherings

The agency advised all countries to be on the alert for signals related to patients presenting with a rash that progresses in sequential stages – macules, papules, vesicles, pustules, scabs, at the same stage of development over all affected areas of the body – that may be associated with fever, enlarged lymph nodes, back pain, and muscle aches.

The latest guide reads: “Gatherings and events where physical contact, may be involved may represent a conducive environment for the transmission of monkeypox virus if they entail close, prolonged or frequent interactions among people, which in turn could expose attendees to contact with lesions, body fluids, respiratory droplets and contaminated materials.”

Monkeypox: How a global health emergency is decided

A Public Health Emergency of International Concern (PHEIC) is the rarely-used top alert available to the WHO to tackle a global disease outbreak.

The conditions which must be met are set out under the 2005 International Health Regulations (IHR) — the legal framework defining countries' rights and obligations in handling public health events that could cross borders.

Definition of 'Public Health Emergency of International Concern'

Under the regulations, a PHEIC is defined 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".

The definition implies that the situation is serious, sudden, unusual or unexpected, and that it carries implications for public health beyond an affected country's border, and may require immediate international action.

Here is a look at how the decision is made and previous PHEIC declarations:

Emergency committee

The WHO's 16-member emergency committee on monkeypox is chaired by Jean-Marie Okwo-Bele from the Democratic Republic of Congo, who is a former director of the WHO's Vaccines and Immunisation Department.

The committee brings together virologists, vaccinologists, epidemiologists and experts in the fight against major diseases. It is co-chaired by Nicola Low, an associate professor of epidemiology and public health medicine from Bern University.

The other 14 members are from institutions in Brazil, Britain, Japan, Morocco, Nigeria, Russia, Senegal, Switzerland, Thailand and the United States. Eight advisers from Canada, the DRC, South Africa, Sweden, Switzerland and the United States also take part in the meetings.

But it was unable to reach a consensus on whether or not to trigger the highest alert, Tedros said Saturday, so the WHO chief then had to decide himself.


The emergency committee provided WHO chief Tedros Adhanom Ghebreyesus with an assessment of the risk to human health, the risk of international spread and the risk of interference with international traffic.

But it was unable to reach a consensus on whether or not to trigger the highest alert, Tedros said Saturday, so the WHO chief then had to decide himself.

 Six previous PHEICS 

The WHO has previously declared a PHEIC six times:

- 2009: H1N1 swine flu

The pandemic was first detected in Mexico and then quickly spread across the United States and the rest of the world.

- May 2014: Poliovirus

Declared following a rise in cases of wild polio and circulating vaccine-derived poliovirus. Besides Covid, it is the only PHEIC still in place.

- August 2014: Ebola

Outbreak in western Africa which spread to Europe and the United States.

- February 2016: Zika virus

The epidemic began in Brazil and heavily affected the Americas. The only PHEIC declared over a mosquito-borne virus.

- July 2019: Ebola

The second Ebola PHEIC was over the outbreak in Kivu in eastern DRC.

- January 2020: Covid-19

Declared when - outside of China where the virus first emerged - there were fewer than 100 cases and no deaths.

COVID-19 frustrations
The COVID-19 PHEIC declaration came after a third meeting of the emergency committee on the spreading virus. Meetings on January 22 and 23, 2020 decided that the outbreak did not constitute a PHEIC.

Despite the declaration, it was only after March 11, that Tedros described the rapidly worsening situation as a pandemic, leading many countries to wake up to the danger.

The sluggish global response still rankles at the WHO's headquarters and raised questions about whether the PHEIC system under IHR was fit for purpose.

"The warning in January was way more important than the announcement in March," WHO emergencies director Michael Ryan said on the second anniversary of the pandemic declaration. "People weren't listening. We were ringing the bell and people weren't acting."

[With inputs from agencies]