‘Real Risk’ Monkeypox Gaining ‘Foothold’ In Europe Amid Escalating Outbreak, WHO Warns

Topline

There is a “real risk” that monkeypox will gain a foothold in Europe, the World Health Organization warned on Wednesday, as it urged governments to take action to curb transmission and engage at-risk groups while warning against stigmatizing tropes that could undermine the public health response.

The WHO warned monkeypox may get a foothold in Europe.

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Key Facts

Europe is at the epicenter of an “escalating” monkeypox outbreak, with 25 countries reporting more than 1,500 cases, 85% of the global total, said the WHO’s European director Dr. Hans Kluge in a news briefing.

The scale of the outbreak means there is a “real risk” the disease will gain a foothold in Europe and other countries where monkeypox does not normally circulate, Kluge said.

Kluge urged governments to boost surveillance, engage with at-risk communities and collaborate internationally to curb transmission and warned that the longer the virus was allowed to spread, the stronger footing it would be on.

However, mass vaccination is not recommended or needed, Kluge said, adding that monkeypox is no reason for canceling large events like music festivals and Pride this summer, which are “powerful opportunities” to raise awareness.

While the majority of cases in Europe have been among men who have sex with men, Kluge stressed that the virus is not “attached to any specific group” and urged against undermining the public health response by stigmatizing certain communities.

Speaking at the same briefing, Steve Taylor, Director of the European Pride Organizers Association, praised the WHO’s efforts to ground responses in evidence and not stigma and said the some 750 Pride events planned across Europe this summer mark a good opportunity to help give people the information needed to protect themselves and their communities.

Key Background

Monkeypox is a well-known virus that normally circulates in parts of Western and Central Africa. Its discovery in Europe and North America, apparently the source of local transmission not linked to travel, in May alarmed scientists and public health officials. The disease is usually mild and resolves itself within a matter of weeks, with key symptoms including a fever and distinctive rash, though it can be fatal. More than 1,600 cases have been confirmed in newly affected countries and another 1,500 cases are suspected, the WHO said. No deaths have been reported in newly affected countries, though the WHO said it is working to verify news reports of one death in Brazil. At least 72 people have died from the disease in previously affected countries. The spread of the disease among men who have sex with men in Europe and local spread in parts of Africa have sparked a flurry of racist and homophobic reporting and the WHO is now pushing for the virus and disease to be renamed to “minimize the negative impact.”

What To Watch For

An escalating WHO response. The WHO is convening an emergency meeting next week to decide whether the monkeypox outbreak represents a Public Health Emergency of International Concern (PHEIC), the organization’s highest alert level. WHO Deputy Director for Emergency Response Ibrahima Socé Fall said the organization did not “want to wait until the situation is out of control” when announcing the meeting on Tuesday. Nations have a legal duty to respond to a PHEIC and take steps to address the outbreak. Since being introduced into international law in 2007, there have been six PHEIC declarations: the 2009 H1N1 swine flu pandemic, the 2014 to 2016 Ebola outbreak in West Africa, the 2016 Zika outbreak, the 2018 to 2020 Ebola outbreak in the Democratic Republic of the Congo and the ongoing Covid-19 pandemic. Polio is the longest running PHEIC. It was declared a PHEIC in 2014 and remains one today.

Crucial Quote

Kluge criticized the “me first” approach many wealthier countries take when it comes to health, as has happened with outbreaks like Covid in the past. “For decades, monkeypox has been endemic in parts of western and central Africa – and for decades it has been neglected by the rest of the world,” he said. Such an approach can “lead to damaging consequences down the road,” he warned, urging governments to “tackle monkeypox without repeating the mistakes of the pandemic – and keeping equity at the heart of all we do.”

Big Number

110,000. That’s how many doses of Bavarian Nordic’s monkeypox vaccine the EU secured on Tuesday. While not approved for use against monkeypox in Europe—it is in Canada and the U.S.—it is authorized for use against smallpox, a biologically similar virus. These similarities mean treatments and vaccines developed for smallpox are also effective against monkeypox. The WHO’s Kluge warned supplies of vaccines and drugs are limited, however, and up-to-date data on their use is scarce. As the only human disease to be eradicated by vaccination and one of history’s biggest killers, access to smallpox is tightly controlled (two known samples remain in secure national laboratories in Russia and the U.S.) and most data comes from either old clinical studies or those involving animals.

What We Don’t Know

If monkeypox is transmitted sexually. The monkeypox virus is not known to be sexually transmitted, although the close physical contact that can be assumed is the primary way the virus spreads. The pattern of the outbreak in Europe, particularly among men who have sex with men, had scientists wondering whether the virus could also spread through sexual contact and researchers in Europe have recently detected the virus in the semen of patients in Italy and Germany. Catherine Smallwood, who is the monkeypox incident manager at the WHO in Europe, said the organization is investigating the possibility the disease could be sexually transmitted but stressed that the focus should be on the most “frequent mode of transmission,” skin to skin contact.