COVID-19 is far from over, and we are hearing news about monkeypox outbreaks in more than a dozen countries. That’s unsettling, for sure, but from a global health security perspective, monkeypox and COVID-19 don’t raise the same concerns – at least not yet. And despite some chatter to the contrary, the WHO isn’t even close to declaring monkeypox an international health emergency.
Friday morning, news circulated on some well-known twitter accounts that the WHO had convened a committee of experts to decide whether to declare monkeypox an international emergency. Only it had not. In actuality, the WHO convened a “Strategic and Technical Advisory Group” to advise on medical developments, and strategies for preparedness and response related to monkeypox. To be sure, the group does scan the horizon for potential global health threats, and in that way provides an early warning system of sorts. But today’s meeting won’t result in a declared monkeypox emergency; that’s not what STAG does.
We have to wait and see whether the WHO convenes its “Emergency Committee” – that’s the group authorized under international health regulations to advise the Director General on whether to declare a Public Health Emergency of International Concern.
Even if the EC is called together, however, the outcome will still be hard to predict because they’ll have to consider not only the seriousness of the disease, but whether it is spreading across international borders. That a disease is “present” in different countries won’t automatically trigger an emergency declaration, especially if those countries can treat and contain the disease on their own. Reports that a patient in Massachusetts contracted monkeypox in Canada, for example, would certainly interest the committee, but they’ll want to know more about how and where it is spreading – did that patient contract it in Canada and simply come to the US for treatment, or is there an indication that the disease is spreading across the border? In 2013, the emergency committee declined to declare an emergency after MERS was reported in a number of countries, primarily because most cases were confined to hospitals.
The WHO has convened the EC 9 times, and it has declared 6 international public health emergencies. International Health Regulations provide criteria to guide the committee’s decision, but deliberations are confidential, and the basis for the committee’s action is often unclear. The Committee waited months before declaring an emergency for ebola in the Democratic Republic of Congo, and of course came under scrutiny for delaying its response to COVID-19 in 2020. Those delays cost lives, so it’s possible a committee called together to consider monkeypox would feel pressure to move quickly. But at the same time, it would have to balance the likelihood that once an emergency is declared, countries will move to impose measures that will impact travel and trade – measures that might range from simple guidance and medical advice, to screening questions, to outright travel bars as we saw during COVID. The most aggressive travel restrictions can be useful in the short run, but can crush the economies of countries that rely on trade and tourism, especially those with fragile economies and limited health capacities – making it harder to contain the disease in the long run. More than $2 billion was lost in west Africa following the 2014-16 ebola outbreak, due in part to travel and trade restrictions.
Institutional considerations will also come into play. The EC routinely cautions against travel restrictions in response to an international health emergency, but countries frequently disregard those recommendations, and implement travel restrictions anyway. And the WHO doesn’t have a formal mechanism to enforce compliance – it’s an honor system, by and large. So every time the EC declares a public health emergency, it risks a reaction from member states that could undermine the legitimacy of the WHO. That’s a significant consideration for an institution that relies on trust and voluntary cooperation from member states in order to address public health emergencies.