In July 2022 the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, declared monkeypox to be a Public Health Emergency of International Concern (PHEIC). This is the seventh of its kind since 2005.
The PHEIC is overseen by the International Health Regulations (IHR) and is declared when the outbreak is an “extraordinary event; when it constitutes a public health risk to other states through international spread; and when a coordinated international response is potentially required.”
The IHR formed a technical Emergency Committee (EC), comprising experts in the appropriate field of each disease. The EC informs the WHO Director-General whether a disease should be described as a PHEIC. In the previous 6 PHEICs the Director-General has taken the advice of the EC. However, in the most recent situation, the Director-General took his own initiative against the vote of the EC.
Writing in The Lancet in August 2022, Dr Clare Wenham and Dr Mark Eccleston-Turner reflected that the decision of the Director-General to overrule the EC demonstrates the WHO is a “politically engaged actor, capable of embracing and engaging with political considerations”. They suggest that this “dimension” shows a “commitment to protecting traditionally marginalised groups from technical decision-making bodies”.
“The decision to declare monkeypox a PHEIC is a much-needed development for an increasingly politicised WHO”
Drs Wenham and Eccleston-Turner further suggest that during the Covid-19 pandemic the WHO lost “influence and authority” due to the deviance of member states from WHO recommendations. Therefore, the PHEIC declaration might be considered an “attempt to reclaim some authority in global disease control”.
However, the tension between the Director-General and the EC may present member states with the opportunity to ignore recommendations from the WHO. It is hoped that the declaration might generate “increased support, vaccine production, and more equitable access to such vaccines or medical countermeasures”.
“The PHEIC is the switch to turn on action”
The authors note that the field, so “dominated by evidence-based decision making” will require more than the “assumption of the normative power of the PHEIC”. As we observe consecutive emergencies, we can discern the effectiveness of their nominal updates. Will monkeypox countermeasures be generated in a more collaborative fashion because of this decision? Unfortunately, only time will tell.
To participate in a day of monkeypox discussion at the World Vaccine Congress in Europe 2022 click here to get your tickets!