TThe World Health Organization ended the global mpox emergency on Thursday, saying that while the virus continues to spread internationally, steady progress has been made in containing the outbreak.
The decision, announced by WHO Director-General Tedros Adhanom Ghebreyesus, came less than a week after the UN health organization announced the end of the global health emergency for Covid-19.
Tedros ended the mpox Public Health Emergency of International Concern, or PHEIC, on the advice of a panel of independent experts, which met Wednesday. He said that while he declared the PHEIC past, mpox still faces significant challenges that require a long-term, sustainable response.
“I am pleased to declare that mpox is no longer a global health emergency. But as with Covid-19, that doesn’t mean the work is over,” Tedros said.
Although the PHEIC has ended and the growth of new cases is well below last summer’s high, Tedros stressed that there is a risk of a resurgence of transmission; he urged countries to look forward to such a turnaround. Pride month and summer festivals attended by gay and bisexual men who have sex with other men could lead to increased transmission, public health experts warn.
Still, Nicola Low, co-chair of the mpox emergency committee, said the group determined at this point it was necessary to focus on long-term efforts to end human-to-human transmission of the virus rather than the kinds of measures needed to an emergency call.
Mpox – formerly known as monkeypox – is a disease caused by a smallpox virus that causes smallpox-like lesions on the skin and mucous membranes of people who become infected with it. The virus is a less serious cousin of smallpox, which was declared eradicated in 1980. Smallpox remains the only human pathogen that has been eradicated.
Smallpox could be eradicated because it had no animal reservoir; it only infected humans. Mpox, on the other hand, can infect a range of animals, including many species of small rodents. While the name would suggest that monkeys are its natural reservoir, that is not true. Monkeys were the first species to be infected with the virus in 1958. But they are not the natural host.
Mpox lesions can be scattered or focused in a particular area of the body. Some people develop many lesions, some just a few. Lesions are commonly found on the face, palms, and soles of the feet. In this outbreak, where the virus has spread mainly through sexual contact, lesions have often been reported on the penis or around the anus, in the throat or rectum.
Transmission can occur through respiratory droplets or through contact with infected skin. The virus can also spread by handling items contaminated with pus or scabs from lesions, such as bedding.
It is not known how long the mpox virus has been circulating outside of the countries in Africa where it is endemic, although sporadic cases have been detected in recent years in people who originated from or had traveled to one of the endemic countries.
The world’s first realized international spread was underway last May, when Britain’s Health Security Agency announced that four men had tested positive for the virus. None of the men had traveled outside the UK. None of them had had contact with known mpox cases. However, all four were men who had sex with men.
It was soon apparent that the virus had spread to multiple parts of the world, apparently fueled by the lifting of Covid-related restrictions on travel and mass gatherings.
In late July, Tedros declared mpox a global health emergency, even though the emergency committee could not agree that the event deserved that designation. On August 2, 2022, Secretary of Health and Human Services Xavier Becerra declared mpox a public health emergency. That statute was may expire the end of January.
In the intervening months, 111 countries have reported nearly 87,400 confirmed and nearly 1,100 probable cases of mpox, 140 of which were fatal. Most cases were reported by countries that had not previously seen mpox cases. Most infections are in men who have sex with men.
This has been reported by the United States highest number of cases, more than 30,000; it also has the highest death toll, 42.
The surge in confirmed cases worldwide peaked in the week of August 8, 2022, when nearly 7,600 cases were recorded. Currently, according to the WHO’s mpox trackernew cases are confirmed at a rate of about 123 per week.
The initial response to the outbreak was criticized at the time, with public health officials – fearful their posts could fuel homophobia – hesitated to openly link the spread of the virus to gay and bisexual men. Initial delays in testing and the slow rollout of limited supplies of mpox vaccines and the antiviral drug tecovirimat, or TPOXX, were also criticized.
But as the summer progressed, at-risk men reported making changes to their sexual lifestyle and vaccination rates increased.
While far fewer new cases are being discovered than at the peak of the outbreak, in 2023 one can now contract mpox in many more parts of the world than was the case a few years ago. That reality is unlikely to change for the foreseeable future.