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The World Health Organization (WHO) has declared the growing monkeypox outbreak a global emergency — the United Nations agency's highest level of alert.
Announced by WHO director-general Tedros Adhanom Ghebreyesus, the declaration of a public health emergency of international concern (PHEIC) marks an escalation in the response to the disease.
So, what does it all mean?
PHEIC? What's that?
It's part of the international health regulations (IHR) which have been the governing framework for global health security since 2007.
A PHEIC is a declaration by the WHO of "an extraordinary event" which spans numerous countries and requires an international response.
Nations have a legal duty to respond promptly to a PHEIC.
The WHO makes such a declaration to bring more attention and more resources to the effort to control an outbreak.
Why declare it now?
Based on the comments of the WHO director-general, it seems the accelerating spread of monkeypox — and a poor understanding of the disease — weighed heavily on the decision to declare an emergency.
WHO's emergency committee met last month but decided against making the declaration.
At that time, there were 3,040 cases in 47 countries.
Now there are 16,000 cases in 75 countries and there have been five deaths in the intervening period.
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Was there a consensus at WHO about the decision?
No.
In a first for the WHO, Dr Ghebreyesus made the declaration without a consensus from his panel of experts, who were split over whether a declaration was warranted.
In explaining his decision to act as a "tie breaker", Dr Ghebreyesus said the advice from the emergency committee only constituted one of five "elements" he was required to consider.
The other four were: information provided by countries, international health regulations criteria (which he said had been met), "scientific principles, evidence and other relevant information", and the risk to human health.
Has this happened before?
Yes. Six times:
- 2020 — COVID-19
- 2018-20 — Kivu Ebola
- 2016 — Zika virus
- 2014 — Ebola
- 2014 — Polio
- 2009 — Swine flu
What exactly is monkeypox?
You can find a detailed rundown here. But here's the short version.
First discovered in 1958 in colonies of monkeys, monkeypox is similar to, but less severe than, smallpox.
It mostly occurs in western and central Africa and the first case in a human was recorded in the Democratic Republic of Congo in 1970.
The symptoms usually last for two to four weeks and can include fever, headache, swollen lymph nodes, back and muscle pain, lack of energy, and the lesions for which it is named.
What does it look like?
Not nice.
The disease causes a rash that turns to lesions filled with fluid or pus.
Like other members of the pock family, think chickenpox and cowpox, it can leave permanent scars.
How do you catch monkeypox?
University of Queensland infectious diseases expert Paul Griffin has some comforting words here.
"It doesn't spread anything like COVID or respiratory viruses, and usually people who get this infection actually have pretty obvious symptoms," he says.
In Africa, it mainly spreads to people from infected wild animals like rodents, but its emergence in Europe and North America has seen it spreading among people with no links to animals or recent travel to Africa.
WHO's top monkeypox expert Rosamund Lewis says 99 per cent of all the monkeypox cases beyond Africa have been men, and of those, 98 per cent have involved men who have sex with men.
Where is it?
The US Centers for Disease Control and Prevention says more than 16,000 cases of monkeypox have been reported in 75 countries since May, when authorities detected dozens of epidemics in Europe, North America and elsewhere.
It has been established in parts of central and west Africa for decades.
To date, monkeypox deaths have been reported only in Africa, where a more dangerous version of the virus is spreading, mainly in Nigeria and Congo.
What about Australia?
The disease was first reported in Australia on May 20, with the federal health department reporting 41 confirmed and probable cases in its most recent update on July 19.
New South Wales and Victoria account for more than half of the cases, with the disease also detected in the ACT, Queensland, South Australia and the Northern Territory.
There have been no fatalities linked to the disease in Australia.
What's the vaccine situation?
The WHO says smallpox vaccines are about 85 per cent effective in preventing monkeypox.
Vaccines specific to monkeypox are in short supply and Australia's federal health department says the risk-benefit assessment for vaccinating people against monkeypox "is complex".
A live-attenuated smallpox vaccine called ACAM2000 is available in Australia and can be used before or after exposure.
But the Australian Technical Advisory Group on Immunisation (ATAGI) says ACAM2000 has been linked to "rare but serious adverse events" and is not suitable for severely immunocompromised people.