The World Health Organization’s Director-General Dr. Tedros Adhanom Ghebreyesus declared the escalating global monkeypox outbreak a Public Health Emergency of International Concern (PHEIC) on Saturday. This is an escalated status but below the requirements needed for a declaration of a pandemic, in part over its low death rates.

Currently, the vast majority of reported cases are in the WHO European Region. “WHO/Europe remains committed to partnering with countries and communities to address the outbreak with the required urgency,” Dr. Tedros said during a media briefing.

In laying out reasons for the declaration the WHO head noted; “We have an outbreak that has spread around the world rapidly through new modes of transmission, about which we understand too little,” Tedros said. “I know this has not been an easy or straightforward process and that there are divergent views.”

There had been reservations by the health agency’s expert committee who said the monkeypox outbreak did not yet amount to an international emergency in a meeting in June. Tedros had reconvened that committee in a special session this past Thursday.

“A month ago, I convened the Emergency Committee under the International Health Regulations to assess whether the multi-country monkeypox outbreak represented a public health emergency of international concern,” Tedros told reporters. “At that meeting, while differing views were expressed, the committee resolved by consensus that the outbreak did not represent a public health emergency of international concern.”

“At the time, 3040 cases of monkeypox had been reported to WHO, from 47 countries. Since then, the outbreak has continued to grow, and there are now more than 16 thousand reported cases from 75 countries and territories, and five deaths,” he added.

“In light of the evolving outbreak, I reconvened the committee on Thursday of this week to review the latest data and advise me accordingly. I thank the committee for its careful consideration of the evidence, and issues,” Tedros continued.

“On this occasion, the committee was unable to reach a consensus on whether the outbreak represents a public health emergency of international concern. The reasons the committee members gave for & against are laid out in the report we are publishing today.”

“Under the International Health Regulations, I am required to consider five elements in deciding whether an outbreak constitutes a public health emergency of international concern.”

“First, the information provided by countries – which in this case shows that this virus has spread rapidly to many countries that have not seen it before. Second, the three criteria for declaring a public health emergency of international concern under the International Health Regulations, which have been met. Third, the advice of the Emergency Committee, which has not reached consensus. Fourth, scientific principles, evidence and other relevant information – which are currently insufficient and leave us with many unknowns. Fifth, the risk to human health, international spread and the potential for interference with international traffic,” Tedros told the press laying out the foundation to his decision.

“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 said adding “There is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the moment.”

“So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations.” The WHO chief then noted “For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern.”

Tedros then pivoted to WHO recommendations for the international public health community in addressing the outbreak.

“Accordingly, I have made a set of recommendations for four groups of countries: First [group], those that have not yet reported a case of monkeypox, or have not reported a case for more than 21 days. Second [group], those with recently imported cases of monkeypox and that are experiencing human-to-human transmission. This includes recommendations to implement a coordinated response to stop transmission and protect vulnerable groups; to engage & protect affected communities; To intensify surveillance & public health measures; To strengthen clinical management & infection prevention & control in hospitals & clinics to accelerate research into the use of vaccines, therapeutics & other tools; And recommendations on international travel. The third group of countries is those with transmission of monkeypox from animals to humans and the fourth is countries with manufacturing capacity for vaccines and therapeutics.”

Tedros acknowledged the work of the committee saying: “I thank the Emergency Committee for its deliberations and advice. I know this has not been an easy or straightforward process, and that there are divergent views among the members. “The International Health Regulations remains a vital tool for responding to the international spread of disease. But this process demonstrates once again that this vital tool needs to be sharpened to make it more effective.”

“Although I am declaring a public health emergency of international concern, for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” he said. “That means that this is an outbreak that can be stopped with the right strategies in the right groups.”

“It’s therefore essential that all countries work closely with communities of men who have sex with men, to design & deliver effective information & services, and to adopt measures that protect both the health, human rights & dignity of affected communities,” Tedros said and then warned, “”Stigma and discrimination can be as dangerous as any virus.”

The WHO Director-General’s full statement is linked here: (WHO)

The Centers for Disease Control and Prevention released a statement saying that the agency was “supportive” of WHO’s emergency declaration and hoped it would galvanize international action to stamp out the outbreaks. The U.S. has reported more than 2,800 monkeypox cases and sent more than 370,000 vaccine doses to U.S. states reporting cases.

Speaking with reporters Friday, Jennifer McQuiston the Deputy Director for High Consequence Pathogens and Pathology at the Centers for Disease Control and Prevention said that two cases of the monkeypox virus have been diagnosed in children.

“We became aware of these cases just this week, and we’ve been working with the jurisdictions to understand more about these cases,” McQuiston said.

In a Washington Post Live session Friday, CDC Director Walensky, while discussing the highly contagious Omicron BA.5 coronavirus variant and the ongoing monkeypox outbreak, noted that the CDC was made aware of the cases adding that both children “are doing well.” 

McQuiston said that the agency determined that both cases were “likely the result of household transmission” and “had no contact with each other.”

The agency is now aware of at least eight cases in people who identify as cisgender women, McQuiston said. Most cases so far have been among men who have sex with men. The number of cases as of July 22 is a total of 2,891 in the U.S. in 44 states and territories including the District of Columbia.

“There is no evidence to date that we’re seeing this virus spread outside of those populations to any degree, and I think that the primary drivers for this infection in the U.S. remain in the gay, bisexual, and men who have sex with men communities right now,” McQuiston added.