The World Health Organization (WHO) on Saturday declared a ‘public health emergency’ over monkeypox, weeks after debating over sounding the alarm. WHO chief Tedros Adhanom Ghebreyesus said that he had to act as a tie-breaker to resolve a disagreement on whether the outbreak had reached the level of a global health emergency. The virus emerged in West and Central Africa and has been present for decades. However, recently it has rapidly spread across continents, registering spread in the United States, Canada and even India. Europe is among the worst-hit regions.

When is a public emergency declared and what does it mean?

A ‘public health emergency of international concern’ (PHEIC) – the alert issued by the WHO for monkeypox – is the agency’s highest alert level. The WHO defines PHEIC as “an extraordinary event which is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response”.

The definition implies that the situation is serious, sudden, unusual or unexpected, carries implications for public health beyond the affected country’s border. The agency reserves the designation for only those diseases that need a coordinated international response to prevent it from potentially escalating into a pandemic.

The alert has previously been sounded for Ebola, H1N1 Swine Flu, Poliovirus, Covid-19 and Zika Virus.

The conditions are set out under the 2005 International Health Regulations (IHR) – the legal framework defining countries’ rights and obligations in handling public health events that could cross borders.

How did the WHO decide on the monkeypox emergency?

A 16-member emergency committee on monkeypox – chaired by Jean-Marie Okwo-Bele from the Democratic Republic of Congo, a former director of the WHO’s Vaccines and Immunisation Department, and co-chaired by Nicola Low, an associate professor of epidemiology and public health medicine from Bern University – provided the WHO chief with an assessment of the risk to human health, the risk of international spread and the risk of interference with international traffic.

However, nine members were against the designation with six in favour, Tedros told reporters at the press briefing for the WHO alert. “Although I am declaring a public health emergency of international concern, for the moment this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners,” Tedros said.