The World Health Organization (WHO) acted as expected this week and declared Mpox a Public Health Emergency of International Concern (PHEIC). So, a problem in a small number of African countries that has killed about the same number of people this year as die every four hours from tuberculosis has come to dominate international headlines. This is raising a lot of angst from some circles against WHO.
While angst is warranted, it is mostly misdirected. WHO and the IHR emergency committee they convened had little real power – they are simply following a script written by their sponsors. The African CDC, that declared an emergency a day earlier, is in a similar position. Mpox is a real disease and needs local and proportionate solutions. But the problem it is highlighting is much bigger than Mpox or WHO, and understanding this is essential if we are to fix it.
Mpox, previously called Monkeypox (inappropriately) is caused by a virus thought to normally infect African rodents such as rats and squirrels. It fairly frequently passes to, and between, humans. In humans its effects range from very mild illness to fever and muscle pains to severe illness with its characteristic skin rash, and sometimes death. Different variants, called ‘clades’, produce slightly different symptoms. It is passed by close body contact including sexual activity, and WHO declared a PHEIC two years ago for a clade that was mostly passed by men having sex with men.
The current outbreaks involve sexual transmission but also other close contact such as within households, expanding its potential for harm. Children are affected and suffering the most severe outcomes, perhaps due to issues of lower prior immunity and the effects of malnutrition and other illnesses.
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