The Director-General of WHO is pleased to present the Report of the Meeting of the Emergency Committee of the International Health Regulations (2005) (IHR) on the smallpox outbreak of the multinational monkey, held on 23 June 2022, from 12:00 to 17:00. Geneva Time (CEST). The Director-General of WHO agrees with the advice offered by the IHR Emergency Committee regarding the multinational smallpox outbreak and, for the time being, does not determine that the event constitutes a public health emergency of international interest (PHEIC).
Since 11 May 2022, the WHO Secretariat has alerted States Parties to the IHR in connection with this event, through publications on the Event Information Site (a secure platform established by the WHO Secretariat). to share information with States Parties to the IHR). These publications aimed to raise awareness of the scope of the outbreak, inform preparedness efforts, and provide access to technical guidance for immediate public health actions recommended by the WHO Secretariat.
The convening of an IHR Emergency Committee indicates an escalation of the alert level for IHR States Parties and the international public health community, and represents a call to intensify public health actions in response to this event.
The Director-General of WHO took the opportunity to express his sincere gratitude to the President, Vice-President and members of the IHR Emergency Committee, as well as to their advisers.
Minutes of the meeting
The members and advisers of the Emergency Committee were convened in person (chair and vice-chair) and by teleconference, via Zoom.
The WHO Secretariat welcomed the participants. The representative of the Office of Legal Advice informed members and advisers of their roles and responsibilities and identified the mandate of the Emergency Committee in accordance with the relevant articles of the IHR. The Ethics Officer of the Department of Compliance, Risk Management and Ethics provided members and advisers with an overview of the WHO Declaration of Interest process. Members and Advisers were aware of their individual responsibility to disclose to WHO, in a timely manner, any personal, professional, financial, intellectual or commercial interests that may give rise to a perceived conflict of interest or real. In addition, they were reminded of their duty to maintain the confidentiality of the discussions of the meeting and the work of the Committee. Each member and director were surveyed. No conflicts of interest have been identified.
The Chief Legal Officer then facilitated the election of the members of the Committee, in accordance with the regulations and working methods of the Emergency Committee. Dr. Jean-Marie Okwo-Bele was elected Chair of the Committee, Professor Nicola Low as Vice-Chair, and Dr. Inger Damon as Speaker, all by acclamation. The meeting was delivered to the Chair, who presented the objectives of the meeting: to offer views to the Director-General of WHO on whether the event constitutes a public health emergency of international interest and, if so, to offer opinions on possible temporary recommendations.
Presentations
The Director-General of WHO joined in on video and welcomed the participants, welcoming the Committee’s advice on the event.
The WHO Secretariat presented the global epidemiological situation, noting that since the beginning of May 2022, 3,040 cases from 47 countries have been reported to the WHO. Transmission is occurring in many countries that have not previously reported cases of monkeypox, and currently the highest number of cases is recorded in countries in the WHO European region. Initial cases of monkeypox, detected in several countries in different WHO regions, had no epidemiological links with areas that have historically reported monkeypox, suggesting that undetected transmission may have been ongoing for some time. time in these countries. Most confirmed cases of monkeypox are men and most of these cases occur between gay, bisexual and other men who have sex with men in urban areas and are grouped in social and sexual networks.
The clinical presentation is often atypical, with few lesions located in the genital, perineal / perianal, or peri-oral area that no longer extend, and an asynchronous rash that appears before the development of a prodromal phase (i.e., lymphadenopathy, fever, malaise). ). So far there have been few hospitalizations and one death has been reported in an immunocompromised individual. Some preliminary research has estimated that the number of reproduction (R0) is 0.8 and, among the cases identified as men who have sex with men, is greater than 1. The average incubation period of cases reported is estimated at 8.5 days, ranging from 4.2 to 17.3 days (based on 18 cases in the Netherlands). The mean serial interval is estimated at 9.8 days (95% CI 5.9–21.4 days, based on 17 pairs of contact cases in the UK). To date, 10 cases of infection have been reported among health workers, of whom at least nine were non-workers.
Representatives from Canada, the Democratic Republic of the Congo, Nigeria, Portugal, Spain and the United Kingdom updated the Committee on the epidemiological situation in their countries and current response efforts.
The WHO Secretariat then presented the draft of the “WHO Strategic Plan for the containment of the smallpox outbreak in several countries”. The plan emphasized that a strengthened, agile and collaborative approach should be adopted, with a particular focus on raising awareness and empowering affected population groups so that they adopt safe behaviors and risk-based protection measures in which they face, and by stopping a further spread of the monkey’s smallpox inside. these population groups.
The WHO Secretariat also presented its technical guidelines, offered to countries in support of their efforts to respond to this event, and revolving around: enhanced surveillance; case isolation; identification and tracking of contacts; enhanced laboratory and diagnostic capabilities; clinical management and infection prevention and control measures in health and community settings, including care pathways; commitment to affected population groups and effective communication to avoid stigmatization; solid healthcare pathways, including the use of medical countermeasures in collaborative research frameworks, using standardized data collection tools to rapidly increase the generation of evidence on the efficacy and safety of these products.
Deliberative session
Following the presentation session, the Committee met again in closed session to consider issues related to whether or not the event constitutes a PHEIC and, if so, to consider the Temporary Recommendations, drafted by the Secretariat of the ‘WHO in accordance with the provisions of the RSI. At the request of the Chair, the WHO Secretariat reminded Committee members of its mandate and reminded the definition of a PHEIC according to the IHR: an extraordinary event, which poses a public health risk to others. States through international transmission, and that potentially requires a coordinated international response.
The Committee discussed key issues related to the outbreak, such as: current observations of stagnation or potential downward trends in the number of cases in some of the countries that experienced the outbreak from the outset; the need to deepen the understanding of transmission dynamics; challenges related to contact tracking, particularly due to anonymous contacts, and possible links to international meetings and LGBTQI + pride events conducive to increasing opportunities for exposure through intimate sexual encounters; the need for continuous evaluation of interventions that appear to have had an impact on transmission; the identification of key activities for risk communication and community participation, working in close partnership with affected communities to raise awareness of personal protection measures and behaviors during upcoming events and meetings; the need to assess the impact of different interventions, including the evaluation of vaccination strategies implemented by certain countries in response to the outbreak, and the availability and equity in access to and licensing of medical countermeasures.
The Committee was concerned about the potential for exacerbation of the stigmatization and violation of human rights, including the rights to privacy, non-discrimination, physical and mental health, of the affected population groups, which would make it even more difficult. response efforts. In addition, for the protection of public health, some members of the Committee expressed the view that laws, policies and practices that criminalize or stigmatize consensual homosexual behavior by state or non-state actors create barriers to accessing public health. health services and can also hinder the response. interventions.
Additional knowledge gaps and areas of uncertainty, for which more information is needed quickly to support a more complete public health risk assessment of this event, include: modes of transmission; full spectrum of clinical presentation; infectious period; reservoir species and reverse zoonosis potential; the possibility of viruses; and access to vaccines and antivirals and their effectiveness in humans.
The Committee acknowledged that monkeypox is endemic to parts of Africa, where it has been observed to cause disease, including fatalities, for decades, and that the response to this outbreak should serve as a catalyst to increase efforts. to address long-term smallpox and access to essential supplies worldwide.
Conclusions and advice
The Committee noted that many aspects of the current multinational outbreak are unusual, such as the occurrence of cases in countries where the circulation of the monkeypox virus had not been previously documented and the fact that the vast majority of cases they are observed among men who have sex. with men, young, not previously vaccinated against smallpox (knowing that vaccination …