The Emergency Committee recognized that the number of reported cases has continued to drop since its previous meeting and that the worldwide response to the multi-country monkeypox outbreak has improved. The Committee observed no changes in the severity or clinical manifestation of the disease and a considerable decrease in the number of reported cases when compared to the prior reporting period.
The Committee stated that there are still many questions about the illness, including those related to some countries’ ways of transmission, the low quality of some reported data, and the persistent absence of efficient preventative measures in the African nations where mpox is a frequent occurrence. A long-term strategy to manage the public health risks posed by monkeypox, rather than the emergency measures associated with a public health emergency of international concern (PHEIC), would be preferable in the Committee’s opinion because these are long-term challenges.
The Committee emphasized the need for long-term partnerships to mobilize the necessary resources for maintaining surveillance, control measures, and research for the long-term elimination of human-to-human transmission as well as mitigation of zoonotic transmissions, where possible. It was emphasized again that a crucial component of this longer-term transformation is the integration of mpox prevention, readiness, and response into national surveillance and control programmes, especially for HIV and other sexually transmissible illnesses.
The Committee specifically observed that the multi-country outbreak of monkeypox has been substantially brought under control without outside funding support, and that longer-term control and elimination are unlikely without it. In the long run, these persistent efforts will save money, save lives, lower the likelihood of a worldwide mpox comeback, and lower the possibility of reverse zoonosis, which could lead to the virus spreading to new locations.
For the reasons outlined in the meeting’s proceedings below, the WHO Director-General thanks the Chair, Members, and Advisors for their advice and concurs that the event no longer qualifies as a PHEIC. He then issues updated Temporary Recommendations for the transition period, which are presented at the end of this document.
The IHR Multi-Country Monkeypox Emergency Committee’s sixth meeting minutes
The IHR Emergency Committee’s fifth meeting on the multi-nation monkeypox outbreak was held via videoconference, with the Chair and Vice-Chair physically present at WHO headquarters in Geneva, Switzerland. The meeting was attended by eleven of the fifteen Committee members and five of the nine advisors. The WHO Director-General greeted the Committee in his opening remarks and underlined a continuing drop in cases worldwide, with over 90% fewer cases reported in the last three months compared to the prior three months.
The Director-General also pointed out that although the virus is declining globally, it is still spreading in some areas. He also emphasized how crucial it is for nations to continue integrating monkeypox prevention and care into their current national health programs in order to combat outbreaks in the future. The Committee Member and Advisors were briefed by the Office of Legal Counsel’s representative on their duties and authority under the pertinent IHR articles.
The Department of Compliance, Risk Management, and Ethics’ Ethics Officer reminded Members and Advisors of their obligation to maintain the secrecy of Committee discussions and deliberations as well as their personal obligation to promptly disclose to WHO any interests of a personal, professional, financial, intellectual, or commercial nature that might give rise to a perceived or actual conflict of interest.
The meeting was officially opened by Dr. Jean-Marie Okwo-Bele, Chair of the Emergency Committee, who also gave a brief overview of its goals: to discuss whether the multi-country monkeypox outbreak still qualifies as a PHEIC with the WHO Director-General and, if so, to review the proposed Temporary Recommendations to States Parties.
Presentations
Representatives from Japan, Nigeria, and the United Kingdom of Great Britain and Northern Ireland gave updates on the epidemiological conditions that are now in place in their nations and the public health initiatives that are being carried out.
The WHO Region of Africa also offered a further regional update. The Secretariat gave a thorough update on the epidemiological situation and the ongoing response operations. Since January 2022, more than 1500 cases have been confirmed in 13 countries, according to the WHO Region of Africa, with the majority of these cases coming from Nigeria and the Democratic Republic of the Congo. The quality of the data reported through the surveillance systems was inconsistent, and there was limited information available on the modes of transmission in the African Region.
According to the Secretariat, the probability of a multi-country monkeypox outbreak is now estimated to be low in South-East Asia and the Western Pacific areas, but moderate globally and in four of the WHO areas. The 22nd External Situation Report contains further information. At this website, 2022 Monkeypox Outbreak: Global Trends, all information is accessible, and case numbers are updated every week.
In addition, the Secretariat informed the Committee that the WHO Monkeypox Strategic preparedness, readiness, and response plan will expire in June 2023 and that plans are being made to create a long-term strategy for the management and eventual eradication of human-to-human transmission as well as a country planning guide to support its implementation.
Following the presentations, Committee Members and Advisors had a question-and-answer session with the Secretariat and the presenting countries.
Discussion meeting.
The Committee met again behind closed doors to discuss whether the incident still qualifies as a PHEIC and to offer advice on the proposed Temporary Recommendations in accordance with IHR guidelines.
The Committee acknowledged that there had been no significant changes in the demographics or severity of clinical manifestations since the last meeting, and that the main causes of deaths and severity remained untreated HIV infections and immunosuppression.
The Committee also acknowledged the continued progress since the last meeting in reducing the number of cases and deaths. The Committee acknowledged certain lingering issues, including the length of immunity following infection or vaccination, breakthrough infections in completely immunized individuals, and occurrences of reinfection; a lack of reliable data regarding the effectiveness of vaccines; Given the unreliable data and inconsistent case reporting to WHO, particularly in nations where the disease is a regular occurrence.
The Committee also observed that the risk assessment had not changed since the last meeting. It was highlighted that recent and recent huge social events hosted in several nations did not result in surges in the number of cases, but some concerns were raised over the possible influence of these meetings among high-risk groups. It was also mentioned that some areas had begun to create post-emergency plans and had started integrating the response into programs for sexually transmissible infections.
The Committee expressed concern over the ongoing knowledge gaps surrounding mpox in Africa, the lack of vaccines, medications, and diagnostic testing capabilities in many low-income nations, the persistent zoonotic transmission in Africa, and the fact that not all nations are getting the support they require or have the structures or systems necessary to respond to monkeypox, including insufficient support for marginalized groups.
In conclusion, the Committee recommended that the event requires a transition from a PHEIC to a robust, proactive, and sustainable monkeypox response and control program, that prevents resurgence of global spread, strives to eliminate person-to-person transmission, and mitigates the impact of local spill-over effects. This recommendation took into consideration the significant decline in the global spread of monkeypox as well as the gains achieved in controlling the outbreak in many countries.
The Committee advised that Standing Recommendations under the IHR would now be a more appropriate tool to manage the immediate, short-term, and long-term public health risks posed by mpox. The Committee emphasized the need for long-term attention and support, including financial support, particularly for countries where monkeypox occurs frequently.
The Committee emphasized the necessity of enlisting partners and funds for a consistent, WHO-led strategy to enhance surveillance, research, and control measures, as well as to give priority to and invest in African nations and other underserved communities where mpox readiness and response efforts are still insufficient. Among other identified gaps, these efforts should focus on research, risk communication, laboratory testing, data quality, access to vaccinations and treatments, and surveillance.
The Committee gave input on the draft temporary recommendations with the understanding that the WHO director-general could continue to release them if necessary after the PHEIC was terminated. The Committee further stressed the necessity for IHR States Parties to increase their dedication and responsibility in carrying out the interim recommendations.
The Committee further advised monitoring regarding any fresh, noteworthy incident or the appearance of fresh information that would necessitate reevaluating mpox as a PHEIC.
WHO Director-General’s Temporary Recommendations Regarding the Multi-Country MPox Outbreak
The objective of the WHO Strategic Preparedness, Readiness and Response Plan for Monkeypox 2022–2023 and the operational guidelines of the WHO are to stop the outbreak and achieve the goals of interrupting human–to–human transmission, protecting the vulnerable, and minimizing zoonotic transmission of the virus. These Temporary Recommendations continue to support these goals.
Any State Party may face the local or imported spread of mpox, and certain States Parties may also be experiencing the spread of zoonotic diseases. In order to further promote mpox control and eventually eliminate human-to-human transmission, these Temporary Recommendations are applicable to all States Parties in all phases of mpox readiness or response, as described in earlier sets of Temporary Recommendations. States Parties should continue to advocate for expanding access to medical countermeasures in low- and middle-income nations.
The principles outlined in Article 3 of the IHR should be followed by States Parties when implementing these Temporary Recommendations to ensure complete respect for the dignity, human rights, and fundamental freedoms of individuals. The WHO recommends States Parties to maintain readiness and response capability through a One Health strategy in conjunction with important communities, partners, and other stakeholders.
To meet the objectives above, States Parties should:
Main tenets of the mpox response plan should be maintained and promoted, and their experience should be reviewed in order to inform public health policies, programs, and activities. To prevent and stop human-to-human transmission and/or to mitigate zoonotic transmissions, develop and put into action integrated mpox control plans and an elimination strategy. Maintain epidemiological monitoring of measles, making every effort to achieve laboratory confirmation of suspected cases and reporting of confirmed and probable cases to WHO in accordance with the criteria outlined in the WHO Case Reporting Form.
All confirmed mpox cases associated with travel should be reported right away to WHO using the procedures specified by IHR regulations. As necessary, include mpox detection, prevention, care, and research into creative HIV and STD prevention and control programs as well as other health services. Maintain and invest in risk communication, community involvement, and support for impacted and at-risk populations, especially through civil society and health authorities.
Maintain your intervention efforts to prevent stigma and discrimination against any people or groups who may be impacted by mpox. To advance global health equity, support and improve access to diagnostics, vaccines, and therapeutics, especially for the majority of affected communities worldwide, such as gay, bisexual, and other men who sex with men, with a focus on those who are most marginalized within those groups, as well as in resource-poor nations where mpox is endemic.
Continue to improve genomic sequencing, decentralized testing access, and diagnostic capability, including the exchange of genetic sequence information through open databases. Continue providing primary preventive (pre-exposure) and post-exposure vaccination with vaccinations to people and communities at high risk for measles.
Make careful to provide the best possible clinical care in all clinical settings, with infection prevention and control strategies in place for suspected or confirmed mpox. Make sure that healthcare professionals are properly trained. Boost capability to better understand transmission mechanisms, estimate resource requirements, and respond to outbreaks and persistent chains of transmission in rural and resource-constrained contexts where mpox still occurs.
Create and swiftly distribute knowledge for important scientific, social, clinical, and public health elements of mpox prevention and control by implementing a coordinated research strategy. Continue monitoring vaccine safety, efficacy, and duration of protection from infection and immunization, as well as clinical trials of medical preventatives, such as vaccinations, medicines, and diagnostics, in various populations.
Countries in West, Central, and East Africa where mpox is endemic should put forth more effort to clarify the risk, vulnerability, and impact of mpox as well as to investigate, comprehend, and control mpox in their respective settings, taking into account zoonotic, sexual, and other modes of transmission in various demographic groups.
Technically, all States Parties are still bound by the comprehensive temporary recommendations that were issued on February 15, 2023, following the fourth IHR Emergency Committee meeting. The WHO website contains all of the most recent operational and temporary technical guidelines. The WHO will publish a broad global strategy and new country planning guide for mpox eradication and control as a follow-up to the current Strategic Preparedness, Readiness, and Response Plan.
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