A WHO expert panel has decided that the rapidly growing monkeypox epidemic does not yet warrant a Public Health Emergency of International Concern, which has triggered a new debate about the purpose of the global alarm system.
The World Health Organization may have very high aspirations—“the attainment by all peoples of the highest possible level of health”—but when a new human disease begins to spread, or a known one behaves in unusual, threatening ways, it has few levers to pull. One important decision it can make, however, is declaring a Public Health Emergency of International Concern , a designation that gives WHO some additional powers and serves as a global wake-up call.
WHO has previously come under fire for waiting too long to declare a PHEIC for COVID-19 and Ebola epidemics in West Africa and the Democratic Republic of the Congo. The agency’s “track record is that they tend to be on the later side of things,” says Jeremy Youde, a global health researcher at the University of Minnesota, Duluth.
That leaves just one criterion in doubt, says Alexandra Phelan, a lawyer at Georgetown University who specializes in global health policy: whether the surge is an “extraordinary event.” That determination is tricky because monkeypox is an endemic, if neglected, disease in some African countries. “It is unjust and unethical to determine an event is only extraordinary if it is now occurring in high-income countries,” Phelan says.
How helpful a PHEIC truly is remains a matter of debate as well. The declaration obligates member countries to follow WHO’s recommendations, such as sharing data on cases, and allows the agency to issue travel advice. “To date there is no scientific evidence on the effect a PHEIC has,” Wenham says.
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