Sunday, July 24, 2022

Covid, Zika, Swine Flu, Ebola and Monkeypox: When does WHO trigger highest alert
The World Health Organisation (WHO) headquarter in Geneva. 

The WHO has declared the surge in monkeypox to be a PHEIC after experts reviewed the situation at an emergency committee meeting two days earlier

A Public Health Emergency of International Concern (PHEIC) is the rarely used top alert available to the World Health Organization to tackle a global disease outbreak.

The WHO on Saturday declared the surge in monkeypox to be a PHEIC after experts reviewed the situation at an emergency committee meeting two days earlier.

Here is a look at how the decision is made and previous PHEIC declarations:

What is a PHEIC?

The conditions which must be met 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.

A PHEIC is defined in the regulations 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 an affected country's border, and may require immediate international action.

Emergency committee

The WHO's 16-member emergency committee on monkeypox is chaired by Jean-Marie Okwo-Bele from the Democratic Republic of Congo, who is a former director of the WHO's Vaccines and Immunisation Department.

The committee brings together virologists, vaccinologists, epidemiologists and experts in the fight against major diseases.

It is co-chaired by Nicola Low, an associate professor of epidemiology and public health medicine from Bern University.

The other 14 members are from institutions in Brazil, Britain, Japan, Morocco, Nigeria, Russia, Senegal, Switzerland, Thailand and the United States.

Eight advisers from Canada, the DRC, South Africa, Sweden, Switzerland and the United States also take part in the meetings.

Decision

The emergency committee provided WHO chief Tedros Adhanom Ghebreyesus with an assessment of the risk to human health, the risk of international spread and the risk of interference with international traffic.

But it was unable to reach a consensus on whether or not to trigger the highest alert, Tedros said Saturday, so the WHO chief then had to decide himself.

Six previous PHEICS

The WHO has previously declared a PHEIC six times:

2009: H1N1 swine flu

The pandemic was first detected in Mexico and then quickly spread across the United States and the rest of the world.

May 2014: Poliovirus

Declared following a rise in cases of wild polio and circulating vaccine-derived poliovirus. Besides Covid, it is the only PHEIC still in place.


August 2014: Ebola

Outbreak in western Africa which spread to Europe and the United States.

February 2016: Zika virus

The epidemic began in Brazil and heavily affected the Americas. The only PHEIC declared over a mosquito-borne virus.

July 2019: Ebola

The second Ebola PHEIC was over the outbreak in Kivu in eastern DRC.

January 2020: Covid-19

Declared when -- outside of China where the virus first emerged -- there were fewer than 100 cases and no deaths.

Covid-19 frustrations

The Covid-19 PHEIC declaration came after a third meeting of the emergency committee on the spreading virus. Meetings on January 22 and 23, 2020 decided that the outbreak did not constitute a PHEIC.

Despite the declaration, it was only after March 11, that Tedros described the rapidly worsening situation as a pandemic, leading many countries to wake up to the danger.

The sluggish global response still rankles at the WHO's headquarters and raised questions about whether the PHEIC system under IHR was fit for purpose.

By March 11, the number of cases outside China had soared, with more than 118,000 people having caught the disease in 114 countries, and 4,291 people having lost their lives, following a jump in deaths in Italy and Iran.

"The warning in January was way more important than the announcement in March," WHO emergencies director Michael Ryan said on the second anniversary of the pandemic declaration.

"People weren't listening. We were ringing the bell and people weren't acting, added Ryan.

Monkeypox: US confirms first cases of virus in children, CDC begins probe

The disease has been spreading largely among men who have sex with other men during the current outbreak, outside the central and west Africa where it is endemic.

monkeypox us children
India has confirmed three monkeypox cases — all from Kerala. (File)

The United States has recorded the first cases of the viral monkeypox disease in children. On Friday, two children were diagnosed with the disease, officials of the US Centers for Disease Control and Prevention (US CDC) said.

One of the children is a California toddler and the other an infant who is not a US resident. The US CDC described the children as being in good health and undergoing treatment. It is still being investigated how the two children caught the disease, but the officials think it was through household transmission.

Monkeypox causes flu-like symptoms and skin lesions. The disease has been spreading largely among men who have sex with other men during the current outbreak, outside the central and west Africa where it is endemic, The Guardian reported. The disease spreads mainly through close contact.

This year, 14,000 cases have been recorded in more than 60 countries, including those that historically don’t see the disease. Africa has also recorded five deaths. The vast majority of the infections have happened in the US and Europe. Europe has witnessed at least six cases among children 17 years old and younger. This week, a report by doctors in The Netherlands said a boy who was seen at an Amsterdam hospital with 20 red-brown bumps across his body. He had contracted monkeypox and the doctors said they could not determine how.

The CDC’s Deputy Director in the Division of High Consequence Pathogens and Pathology Dr Jennifer McQuiston said during a conference call it was not a surprise that paediatric cases had emerged, but added “there is no evidence to date that we are seeing this virus spread outside” the communities of gay, bisexual and other men who had sex with men.

She said 99% of the 2,891 monkeypox cases in the US involved men who had sex with men, but a handful of women and transgender men who had also become infected.

White House Covid-19 Response Coordinator Dr Ashish Jha said on the same call the US government had delivered 300,000 doses of a vaccine and was working to expedite the shipment of more doses from Denmark.

The fatality rate during previous outbreaks in Africa of the current strain was about 1%, but this outbreak seems to be less lethal in non-endemic countries.

India has confirmed three monkeypox cases — all from Kerala. On Friday, a 35-year-old man, who had returned from the United Arab Emirates earlier this month, tested positive for monkeypox.

Kerala Health Minister Veena George said the Malappuram native was undergoing treatment at the Manjeri Medical College and his condition was stable.

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