Just days after the COVID-19 pandemic was declared no longer a public health emergency of international concern (PHEIC), mpox has followed suit. Cases of mpox, formerly monkeypox, have declined since the previous meeting of the IHR Emergency Committee. Despite this positive declaration, the Committee acknowledges “remaining uncertainties about the disease”, relating to “modes of transmission”, “poor quality of some reported data”, and “continued lack of effective countermeasures in the African countries” where mpox “occurs regularly”.  

Updates on the situation 

The Director-General, Dr Tedros Adhanom Ghebreyesus, commented on the sustained decline of cases across the world. He noted that almost 90% fewer cases have been reported over 3 months compared to the previous 3 months. However, the virus is still transmitting in certain communities.  

At the meeting, representatives of Japan, Nigeria, and the UK provided updates on the situation within their countries. The Secretariat offered a “comprehensive update” on the epidemiological situation and response efforts, with a further update from the WHO Region of Africa. The Region reported that the majority of the 1500+ confirmed cases since January 2022 have been in Nigeria and the Democratic Republic of the Congo.  

“There was little information on modes of transmission and the quality of reported data through surveillance systems was uneven in the African Region.”  

The current global risk is described as “moderate” across much of the globe.  

Knowledge gaps 

Although progress has been made through a global effort, the Committee recognised “remaining concerns”, which include duration of immunity after infection or vaccination, “insufficient evidence about vaccine effectiveness”, and “poor quality of data and inconsistency in reporting of cases”.  

Despite concerns about the potential effects of large social gatherings among “high-risk groups” it was noted that many gatherings took place last year without a spoke in case numbers. Furthermore, some regions have post-emergency plans and have started to integrate the response into sexually transmissible infection programmes.  

In Africa there are “concerns” about the situation, particularly concerning “recurring zoonotic transmission”. Wider concerns were raised about lack of access to vaccines, medicines, and diagnostic testing in many LMICS. 

“Not all countries are receiving the support they need or have structures or systems to response to mpox, including inadequate support for marginalised groups.” 
Moving to a long-term strategy 

Although the Committee acknowledges the “uncertainties” surrounding mpox, it encourages a transition to a “long-term strategy” instead of the emergency measures demanded in a PHEIC. WHO states that the Committee “emphasised the necessity for long-term partnerships” to “mobilise” the necessary support for “sustaining surveillance, control measures and research for the long-term elimination of human-to-human transmission”, and “mitigation of zoonotic transmissions”.  

“Integration of mpox prevention, preparedness, and response within national surveillance and control programmes, including for HIV and other sexually transmissible infections, was reiterated as an important element of this longer-term transition.”  

The Committee noted that progress has been made “largely in the absence of outside funding support”. Furthermore, “longer-term control and elimination” will be unattainable without such support.  

Temporary Recommendations 

Just as with the COVID-19 change last week, the WHO Director-General issued Temporary Recommendations relating to the outbreak. These are intended to meet the objectives to “interrupt human-to-human transmission, protect the vulnerable, and minimise zoonotic transmission”. 

“In implementing these Temporary Recommendations, States Parties should ensure full respect for the dignity, human rights, and fundamental freedoms of persons.” 
  1.  Sustain and promote key elements of the mpox response strategy and review experience to inform public health policies, programmes, and actions. 
  2. Develop and implement integrated mpox control plans and an elimination strategy with the aim of preventing and stopping human-to-human transmission and/or mitigating zoonotic transmissions. 
  3. Maintain epidemiological surveillance of mpox, making every effort to ensure laboratory confirmation of suspected cases and reporting to WHO of confirmed cases and probable cases. 
  4. Report immediately all confirmed travel-related mpox cases to WHO. 
  5. Integrate mpox detection, prevention, care, and research with existing and innovative HIV and sexually transmitted disease prevention and control programmes, and other health services as appropriate. 
  6. Sustain and invest in risk communication and community support and engagement for affected communities and at-risk groups, including through health authorities and civil society. 
  7. Continue to implement interventions to avoid stigma and discrimination against any individuals or group that may be affected by mpox. 
  8. Support and enhance access to diagnostics, vaccines, and therapeutics to advance global health equity, in particular for most affected communities worldwide, including gay, bisexual, and other men who have sex with men, with special attention to those most marginalised within those groups, and in resource-constrained countries where mpox is endemic. 
  9. Continue to strengthen diagnositc capacity, decentralised access to testing and genomic sequencing, including sharing of genetic sequence data through public databases. 
  10. Continue to make vaccines available for primary preventative (pre-exposure) and post-exposure vaccination for persons and communities at high risk of mpox. 
  11. Ensure provision of optimal clinical care with infection prevention and control measures in place for suspected or confirmed mpox in all clinical settings. Ensure training of health care providers accordingly. 
  12. Strengthen capacity in resource-limited and rural settings where mpox continues to occur, to better understand modes of transmission, quantify resource needs, and respond to outbreaks and sustained chains of transmission.  
  13. Implement a coordinated research agenda to generate and promptly disseminate evidence for key scientific, social, clinical, and public health aspects of mpox prevention and control. Continue clinical trials of medical countermeasures, including vaccines, therapeutics, and diagnostics, in different populations, in addition to monitoring of vaccine safety, effectiveness, and duration of protection from infection and vaccination.  
  14. Countries in West, Central, and East Africa, where mpox is endemic should make additional efforts to elucidate mpox-related risk, vulnerability, and impact, and to investigate, understand, and control mpox in their respective settings, including the consideration of zoonotic, sexual, and other modes of transmission in different demographic groups.  

Do you agree with the change in emergency status?