Monkeypox Virtual Press conference transcript - 23 July 2022

Overview

00:02:14

CL          Hello and welcome, finally, to our update on the report of the second meeting of the IHR Emergency Committee regarding the multi-country outbreak of monkeypox. It is Saturday, 23 July, shortly after four o’clock, 16:00, in Geneva now. And welcome to WHO and this Extraordinary Virtual Press Conference.

Just to flag, because of the special situation, we will not have interpretation today, on this Saturday, so it will be English only, please. Thank you very much. And apologies again for the longer delay we just had, and thank you very much for joining us on a Saturday afternoon or morning or evening, wherever you are in the world.

With this, let me introduce the participants. Present in the room here are Dr Tedros Adhanom Ghebreyesus, WHO Director-General, Dr Mike Ryan, Executive Director for WHO’s Health Emergencies programme. We have Dr Catharina Boehme, Chef de Cabinet at WHO. We, of course, also have Dr Rosamund Lewis, who is the Technical Lead on Monkeypox.

00:03:28

We have Dr Maria van Kerkhove, who is the Technical Lead on COVID-19. We also have with us Tim Nguyen, who is the Unit Head for High Impact Events. And we have two colleagues online for you, and that’s Dr Meg Doherty, who is the Director for the Global HIV, Hepatitis and STI Programmes, and Dr Rogério Gaspar, who is Director for Regulation and Prequalification.

A word on the expected statement that we’ll try to send out as soon as possible. We will send the DG’s statement which you’re about to hear as soon as possible after it’s been delivered. So you can then get the written version as soon as possible after it has been delivered. And with this, Dr Tedros, the floor is yours.

TAG        Thank you, Christian. Good morning, good afternoon and good evening. A month ago, I convened the Emergency Committee under the International Health Regulations to assess whether the multi-country monkeypox outbreak represented a public health emergency of international concern.

At that meeting, while differing views were expressed, the committee resolved by consensus that the outbreak did not represent a public health emergency of international concern. At the time, 3,040 cases of monkeypox had been reported to WHO from 47 countries. Since then, the outbreak has continued to grow, and there are now more than 16,000 reported cases from 75 countries and territories, and five deaths.

00:05:29

In light of the evolving outbreak, I reconvened the committee on Thursday of this week to review the latest data and advise me accordingly. I thank the committee for its careful consideration of the evidence and issues. On this occasion, the committee was unable to reach a consensus on whether the outbreak represents a public health emergency of international concern. The reasons the committee members gave for and against are laid out in the report we are publishing today.

Under the International Health Regulations, I am required to consider five elements in deciding whether an outbreak constitutes a public health emergency of international concern. First, the information provided by countries, which in this case shows that this virus has spread rapidly to many countries that have not seen it before. Second, the three criteria for declaring a public health emergency of international concern under the International Health Regulations, which have been met.

Third, the advice of the Emergency Committee, which has not reached a consensus. Fourth, scientific principles, evidence and other relevant information, which are currently insufficient and leave us with many unknowns. And fifth, the risk to human health, international spread, and the potential for interference with international traffic.

WHO’s assessment is that the risk of monkeypox is moderate globally and in all regions, except in the European region, where we assess the risk is high. There is also a clear risk of further international spread, although the risk of interference with international traffic remains low for the moment.

00:07:42

So in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations. For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern.

Accordingly, I have made a set of recommendations for four groups of countries. First, those that have not yet reported a case of monkeypox or have not reported a case for more than 21 days. Second, those with recently imported cases of monkeypox and that are experiencing human-to-human transmission.

This includes recommendations to implement a coordinated response to stop transmission and protect vulnerable groups. To engage and protect affected communities, to intensify surveillance and public health measures, to strengthen clinical management and infection prevention and control in hospitals and clinics, to accelerate research into the use of vaccines, therapeutics and other tools, and recommendations on international travel.

The third group of countries is those with transmission of monkeypox between animals and humans, and the fourth is countries with manufacturing capacity for diagnostics, vaccines and therapeutics.

00:09:31

My full recommendations are laid out in my statement. I thank the Emergency Committee for its deliberations and advice. I know this has not been an easy or straightforward process and that there are divergent views among the members. The International Health Regulations remains a vital tool for responding to the international spread of disease, but this process demonstrates once again that this vital tool needs to be sharpened to make it more effective.

So I’m pleased that alongside the process of negotiating a new international accord on pandemic preparedness and response, WHO’s Member States are also considering targeted amendments to the International Health Regulations, including ways to improve the process for declaring a public health emergency of international concern.

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. That means that this is an outbreak that can be stopped with the right strategies in the right groups. It’s therefore essential that all countries work closely with communities of men who have sex with men to design and deliver effective information and services and to adopt measures that protect the health, human rights and dignity of affected communities.

Stigma and discrimination can be as dangerous as any virus. In addition to our recommendations to countries, I am also calling on civil society organisations, including those with experience in working with people living with HIV, to work with us on fighting stigma and discrimination. But with the tools we have right now, we can stop transmission and bring this outbreak under control. I thank you. And Christian, back to you.

00:11:56

CL          Thank you very much, Dr Tedros. Let me now open the floor for questions from the media. Again, just to remind you, to get into the queue for asking questions, you need to raise your hand with the Raise Hand icon, and then please don’t forget to unmute yourself. We have a couple of questions already lined up, and we’ll start with Kai Kupferschmidt from Science. Kai, please unmute yourself.

KK         Yes, thank you very much for doing this on a Saturday, and thanks for taking my question. Really briefly maybe, Tedros, could you give an idea of what you were weighing in your mind as well when you made this decision? As far as I understand, it is the first time since the IHR from 2005 that a PHEIC has been declared without the Emergency Committee recommending it. So I’d just be curious to understand a little bit your deliberations on this. And then what do you hope this changes, of course? What do you want to see now?

CL          Thank you very much, Kai, and I guess we’ll start with Dr Mike Ryan.

MR         Thanks, Kai. I don’t pretend to know what is in the Director-General’s mind, but in conversation, it’s quite clear from the DG’s perspective that, yes, you are correct, the DG always listens to and tries to concur with the findings of the committee.

00:13:23

And in this case, he’s not going against their advice or findings. He found that the committee did not reach a consensus despite having a very open, very useful, very considered debate on the issues. In that sense, he’s not going against the committee. What he’s recognising is that there are deep complexities in this issue, there are uncertainties on all sides, and he’s reflecting that uncertainty in his determination of the event to be a PHEIC.

And in that sense, I think, Kai, to answer the second part of your question, I believe what he hopes we can do from here is to intensify our efforts. He sees a window of opportunity to bring this disease under control. He sees that we can redouble our efforts. We can act together in science, together in solidarity in support of those affected. And as he said again and again in his statement, and you’ll find repeated in his report, that all of this must occur with absolute respect for the human rights and dignity of all those affected and all those responding.

So I think this is a call to action. This is not the first. The DG brought the committee together. It was an alert to the world. The WHO has been highly active on this since day one. This is not the beginning of the response. This is an intensification of his calls to the world that we must act now and we must act together, as we have been acting up to now. But like every effort in human science and human health, there are times when you must accelerate that effort. And I think today’s call is for an acceleration of our collective efforts to bring this disease under control.

CL          Thank you very much. And we’ll go to the next question, and that goes to Apoorva Mandavilli from The New York Times. Apoorva, please unmute yourself.

00:15:16

AM         Hi. Thank you for taking my question. Given this emergency that you’re declaring, can you give us an update on the efforts you’re making to get vaccines and drugs to countries that have had limited or no supply at all so far?

CL          Thank you very much for that question. And for vaccine supplies, maybe I’m going to try with Tim Nguyen, who is the Unit Head for High Impact Events. And then, let me see, maybe we have a colleague online also. Let’s go ahead.

TN          Thank you, Apoorva, for your question. So since the beginning of this outbreak, WHO has been in regular contact with the manufacturer of these medical countermeasures, including with Member States who previously have made national stockpiles of smallpox countermeasures available in their national stockpiles. And from these discussions, we know and have an understanding of some of the countries that have access and the global supply situation.

I think, first, when we look at the demand situation of one of the countermeasures, the MVA-BN vaccine, we know that from the countries that are reporting cases at the moment, roughly half of them have already secured access to this vaccine. For the other half, we don’t know for the moment. We have some information that some of them are in discussion with the manufacturers to procure this vaccine.

00:16:52

At the same time, WHO continues to discuss with Member States that are holding larger stockpiles for solidarity in sharing and donating vaccines to those that don’t have access at the moment. So this is an intense effort WHO is doing at the moment.

Secondly, on the supply situation, we have been discussing with those manufacturers what is available in 2022. We have a rough understanding about the three vaccines that are existing at the moment that have been mentioned in the WHO interim guidance for immunisation.

So on the MVA-BN vaccine, we do know that at the moment, 16.4 million doses exist in bulk, which means they require fill and finish. We have roughly 1 million of those already in a fill and finish situation. On the other third-generation vaccine, the LC16 in Japan, we know from the manufacturer that this is only being produced for the government of Japan. And we have good discussion with the government of Japan on how to make some of these accessible to other countries.

And thirdly, on the so-called second-generation vaccine, ACAM2000, we know that roughly 100 million doses of this vaccine exist with various Member States in their national stockpiles. So this is the supply situation in 2022. And we are evaluating with the manufacturer what will be more available in 2023, and these are ongoing discussions.

I would like to underline one thing that is very important to WHO. We do have uncertainties around the effectiveness of these vaccines because they haven’t been used in this context and at this scale before.

00:18:44

And therefore, we are calling on and working with our Member States, that when these vaccines are being delivered, that they are delivered in the context of clinical trial studies, and prospectively collecting this data to increase our understanding on the effectiveness of these vaccines. Thank you.

CL          Thank you very much. And we’ll go to Dr Rogério Gaspar, Director of Regulation and Prequalification. Rogério, please.

RG         Thank you. Thank you so much. I’ll be very quick after what Tim just said, because it’s very exhaustive. Three main points. One is the fact that WHO, together with many regulators in the world, has been coordinating with the R&D Blueprint team inside WHO, preparing for this. So there’s a lot of work that was already in terms of preparation for a scenario like this.

Second one is that we’ll continue to deliver the necessary services to support regulatory systems worldwide. And we are seeing two types of countries, countries that have strong regulatory systems with an evolving situation in terms of the regulatory approval, as we have seen yesterday from the European Medicines Agency, and we have also a responsibility to support Member States that are not in the same situation. We have been preparing for this. The preparation for the support is finalised. So as we have done through COVID-19, we are in a situation to move forward.

00:20:11

The third point is that, of course, having the distribution of vaccines and also therapeutics, because therapeutics is also an important part of this, in terms of the deployment and the monitoring of any eventual safety signals under a context in which part of this context, as the DG just referred, will be to foster the research on this area, with lessons learned from COVID-19 and other vaccines and use of other vaccines, we developed already an app that is ready and tested and prepared to reinforce global pharmacovigilance systems in the deployment of any measures needed, including vaccines and therapeutics. Over from my side.

CL          Thank you very much, both. With this, we have one more from Dr Mike Ryan, please.

MR         Again, in terms of vaccine policy, WHO SAGE have looked at the policies for using this vaccine, and certainly the use of this vaccine is primarily and classically associated with the vaccination of contacts of cases, which is assuming some post-exposure element to the vaccination. There then is the possibility of vaccinating people in advance of being exposed, which is vaccinating an at-risk group.

And in that sense, when we talk about trying to use this vaccine as a measure to stop this outbreak or to control this outbreak, we really want to see these vaccines used in that context, in the context of those most at risk, to protect those most at risk. Those most at risk are those who are currently in contact with the virus or those likely to be exposed to that virus. So in terms of prioritisation here, we need to look at the equity and solidarity issues not purely in a geographic context, but we need to look at these in terms of the people who are most likely to suffer exposure to this disease.

00:22:08

Secondly, it’s important to remember that when this vaccine is given in a pre-exposure context, it is not like giving an antiviral. It takes time for vaccines to work. And in this case, it can take up to three weeks, I believe, for this vaccine to take full effect. So being vaccinated does not give you instant protection. The best way to avoid this infection is to avoid being exposed to it, and if you are exposed to it, to avoid being the person that transmits that further to somebody else.

So breaking the chains of transmission are about preventing onward transmission. That has both a behavioural element but it also has a very strong additional element, that if vaccines are used properly, judiciously and in the right people, vaccines can be very effective at preventing onward transmission of this virus.

CL          Thank you very much, Dr Ryan and all. With this, we move to the next question, and that goes to Jérémie Lanche from RFI. Jérémie, please unmute yourself.

JL           Thank you, Christian. Good morning to everyone. I would like to know, since the vast majority of the cases are reported with men who have sex with men, do you fear that the governments might not take this PHEIC as seriously as the COVID?

CL          Thank you very much, Jérémie. Good question. I guess we’ll go to Dr Mike Ryan.

00:23:35

MR         I think that’s exactly why we’re sitting here today, is because Dr Tedros wants this event to be taken seriously, and to be taken seriously regardless of who it affects in our community. So that is the call today. It is important both that it is taken seriously and we make collective efforts to support the community affected, and in particular, as he says, to empower that community and look to their leadership and the experience that they have had as the most at-risk group. And in this case, it’s men who have sex with men.

There is also always the chance that this disease will extend into further groups, and we have some preliminary evidence that it may do. We know that from the past. We know this disease can transmit in a household setting, but there are that many uncertainties at the moment on transmission of this virus that we have to be exceptionally careful.

But as he said as well, it is exceptionally important that the existence of a public health emergency of international concern and the intensification of surveillance and control efforts are not used as a means for coercive surveillance or for the imposition of measures that would impede the dignity and human rights of the people affected.

It’s very important that we get this balance right. Public health is important. It is very important we extend the same support to communities that are having to comply with measures, and at the same time, that we avoid coercive and excessive measures that are not aimed at containing or controlling the disease but are aimed at isolating or discriminating against a certain section of our population.

00:25:17

CL          Thank you very much. Who wanted to add? Rosamund? Dr Lewis?

RL          Thank you, Christian. Thank you for the question. I can only endorse what has already been said about this issue, that it’s very important to recognise both who is affected in an outbreak, what types of settings in which people can be exposed, the timeframes in which they’re exposed, how long it takes to recognise an infection. These are all critical factors.

And whereas monkeypox is manifesting in new ways, it’s showing new signs, new symptoms in many people, it’s showing less severe illness, but there are also cases who are becoming very ill or suffering extreme pain, which is being taken care of sometimes at home, sometimes in the hospital setting. Meanwhile, others are experiencing less severe conditions and sometimes fewer lesions than might be expected historically from monkeypox.

And so it’s really challenging to message, to communicate about this, to say that it is a disease that is transmitted by person-to-person contact, skin-to-skin, face-to-face. These are all modes of transmission primarily from close contact with people who are having, as I say, very intimate relationships or in the family setting. And so in one sense, it’s possible that transmission can occur in the household, for example.

00:26:52

However, we have many sources of data that are showing, both from the reports coming from countries as well as from studies that are beginning to emerge in the scientific literature as well as from the countries that have presented to the Emergency Committee and informed us of the details of the information that they wish to share regarding this outbreak, that still today, almost three months in, or probably more than three months in given that there was a period of time early on when unusual rashes were not recognised or diagnosed, so still, after three months, 98% of cases are still manifesting in men, and in men who have sex with men, and most of them identify themselves as gay, bisexual or otherwise men having sex with men.

So this is very difficult to communicate, especially for communities who are concerned about stigma, concerned about discrimination, concerned about backlash from other parts of the community or even from their governments. And the Director-General has been very clear today to communicate that stigma and discrimination are not okay. This is important. If we want to help every country and every community control this infectious disease, stigma will not help. It will drive people away from seeking diagnostics, testing, access to care, vaccines, treatments, and this will not help the situation.

As Dr Tedros explained, because at the moment the outbreak is mostly among one population group, that presents an opportunity. It presents an opportunity for us collectively to work with that group, to allow them to bring forward their own ideas, demonstrate their own leadership, of course which they have been demonstrating for many, many years since the beginning of the HIV/AIDS pandemic, and to show us the way, to show us what is the best way to help you, to help countries and to help affected people reduce risk, reduce exposure, reduce transmission and stop this outbreak. Thanks.

00:28:58

CL          Thank you very much for this. And the next question goes to Helen Branswell from STAT News. Helen, please unmute yourself.

HB         Hi. Thank you very much for taking my question. After the first meeting of the Emergency Committee, Dr Tedros, you revealed that although they didn’t vote, that 11 members of the committee felt monkeypox did not meet the criteria to be a PHEIC, and three thought it did. Can you tell us how the committee broke down this time, please?

CL          Thank you, Helen, for this question. Dr Tedros, please.

TAG        Yes. Thank you. Yes, I think during the first meeting, I announced then that they don’t normally vote. It’s not a formal voting. It’s what they call, in French, tour de table. So they just check what the position of the majority is to just sense where the discussion is going. So the 11 in favour, I mean, the 11 who were against declaring a PHEIC and the three who were in favour, you can’t call it a voting, but just some checking that can show the relative positions of people.

Because they provide recommendations to me. If they go to voting, it means it’s a decision. But they don’t. The committee doesn’t decide. At the end of the day, they give advice, they give recommendations, and it’s my responsibility whether to accept it or not. That’s why we don’t call it a voting. I just want to make that clear.

00:30:58

So previously, it was 11-3, and this time, it’s 9-6, nine against and six in favour. And nine and six is very, very close. But at the same time, there was no consensus. The committee couldn’t reach a consensus on which way to go, although those who are against a PHEIC have a simple majority, which is very, very close. So that’s what happened.

Of course, as I said earlier, since the role of the committee is to advise, I then had to act as a tie-breaker. I considered this as a close and no consensus by them. So my colleagues and myself discussed about this issue and we believed that it’s time to declare a PHEIC, or a public health emergency of international concern, considering their advice and considering how it spread even since the last meetings we had.

I think at that time, they were in 37 countries. Now it’s around 75 countries, and counting, by the way. By the day, we see more countries being affected, and we expect that this will continue to be the case. And we considered other factors, and we decided to have a declaration of a public health emergency of international concern. And we believe this will mobilise the world to act together. It needs coordination, and it needs not only coordination but solidarity, especially, as previously asked, the use of vaccines and treatments, and to be able to control the monkeypox outbreak or the spread that we see globally.

00:33:31

CL          Thank you very much, Dr Tedros. With this, we go to the next question. And we go to Simon Ateba from Today News Africa. Simon, please unmute yourself.

SA          Thank you for taking my question. This is Simon Ateba with Today News Africa in Washington. Dr Tedros, you said again that no one should stigmatise anyone. I’m just wondering, do we know why men who have sex with men are affected the most? And can you briefly explain again what it takes to declare an outbreak a public health emergency of international concern? And if you can talk a little bit about how this disease is affecting Africa. Thank you.

CL          Thank you very much, Simon, although there were quite a lot of questions, and given the number of people, I think we’ll restrict it a bit. But we’ll start with Dr Lewis, please.

RL          Sure. Thanks very much. I think there were three questions there, so I’ll start with the first and the third. So why men who have sex with men? Well, I’m sure it’s a question we’ve all been asking ourselves for quite some time now, many weeks. And it has always been known monkeypox has been around, as you say, in Africa. It was first demonstrated there, well, in a person, in a child, in 1970.

00:34:55

The first virus was actually found in a research colony of monkeys in Denmark in 1958. So there were 12 years between the time that the virus was discovered and it was first discovered in a small child, a young infant, around the time of smallpox eradication, just prior to that. And so this virus has been there for a long time. It’s been in human populations for a long time. And you ask a very valid question as to what’s been happening since then.

But let’s come first to the question that the virus has always been known as a zoonotic disease. So it’s a virus that sits or circulates in various animal populations and then can be transmitted to humans in the course of various activities in the natural setting, such as hunting in the forest, preparing meat and things like that, where a contaminated animal can also then infect a person.

However, there has always been information that there is some human-to-human transmission, which has historically always occurred primarily in the family setting at the time when most people were vaccinated against smallpox and so outbreaks would remain fairly small, relatively contained and transmitting in the household amongst family members, for example. That would be a typical outbreak.

Over the course of time, over the course of many years, the chains of transmission of monkeypox have become slightly longer, possibly six, maybe possibly nine sequential chains of transmission, which shows that the virus, the disease was manifesting more in human-to-human transmission.

What is not really known yet, and this is an important feature, is whether that was features that were changes in the virus or whether it was because, as more and more people were born post smallpox eradication, there were fewer and fewer people who were actually collectively immune to orthopoxviruses, because both these viruses are from the same family.

00:36:52

And then there was a different clade of virus in West Africa compared to Central Africa, and this different clade of virus has always presented less severe illness. And therefore, when an illness is less severe, that’s good news, but it also can present more challenges for containment. Because if people are not so sick, then they more easily go out, more easily be in contact with other people.

So again, over the course of time, the countries, one country in particular in West Africa experienced a significant outbreak of monkeypox for the first time in 40 years, and that outbreak was managed by the country, but in fact, the cases never really completely went to zero. And then from that country, other people, travellers began to become infected.

So what we now think has happened, and thanks for the time for the long introduction, but what we now think has happened is that this virus clearly was already moving with people, with travellers, in families, and some spill-over events have continued from animal populations, and the virus has been able to continue moving.

00:37:59

So the hypothesis, and this remains to be confirmed, is that as the virus moved into even a post-COVID world where people were able to travel again, so more travel, more virus was on the move. It established itself in a group that have frequent social gatherings, are together often and also have frequent events involving intimate physical contact and sexual contact, and sometimes sexual contact with multiple partners over a period of a few days or a few weeks.

This is a situation where there is obviously more skin-to-skin, person-to-person contact, close contact situations, settings where there may be many people involved in certain activities. So the mode of transmission initially was not thought to have changed. It’s still skin-to-skin contact.

However, we’re also now beginning to see suggestions that there is also spread from sexual activity in the sense that sexual activity involves, again, very close, intimate contact, including penetrative contact. And that may actually, we don’t yet know, there’s a lot we don’t yet we know about what’s happening now, but certainly, there are possibilities that need to be explored that there are new modes of transmission through sexual activity which have not clearly been described before.

So we have a situation where the virus currently remains, as we said earlier, contained primarily in one population group. It is a population group that are very proactive in health-seeking behaviour and so are coming forward and looking for access to care for diagnosis and to support each other. However, it’s still a group where activities can bring people together, for example, on the margins of pride celebrations, for example, or in places where there are sex-on-premises activities, things like that, that really can put people at risk through immediate possible exposure to the virus.

00:40:03

So this is what we think is happening now, that it’s, as we said, both a challenge and good news that the outbreak remains primarily contained within one population group who are actually already working really very hard to support each other to stop this outbreak.

CL          Thank you very much, Dr Lewis. And I believe, for the second part of the question, this was laid out pretty well in the opening remarks in the statement by the Director-General, so Simon, I’ll refer you to this. I think we have time for one more question, and that goes to Donato Mancini from the FT. Donato, please unmute yourself.

DM         Hi. Thank you so much for taking my question and for organising this on a Saturday. Very simply, is it too late, in your assessment, to control the spread of monkeypox where it is not endemic? So do you expect it will become endemic in more countries as the outbreak progresses? Thank you.

CL          Thank you very much. And we’ll have Dr Lewis start again.

RL          Thank you. Well, we don’t have a crystal ball, so we don’t know for sure if we’re going to be able to support countries enough and communities enough to stop this outbreak. We think it is still possible precisely because it remains primarily in one group, who, as I said, are very active in health-seeking behaviour and supporting each other in reducing risk.

00:41:34

We’d like to encourage that group to continue to undertake the actions both individually and collectively to reduce their own personal risk. It’s only by understanding your risk, understanding modes of transmission that you can assess your own risk, reduce your own risk, protect yourself and protect others.

So we are very much appealing to communities and community leaders who have many years of experience, for example, in managing HIV/AIDS or sexually transmitted infections, to work with more mainstream, if you will, public health officials and public health agencies at the community level, at the local level, as well as civil society organisations. If we all pull together with one single objective, which is to stop this outbreak, and that is really the goal that everyone sets for themselves, then each individual can manage their own risk and each community can support each other to reduce their risk.

And health agencies can support that work and governments can support that work through ensuring human rights and access to services as much as is possible and access to diagnostics as much as is possible, training of health workers, training of clinicians at the front line in all sorts of health services where people may present with what can be a surprisingly diverse presentation of this particular disease.

It can present as fever, it can present as rash, it can present as what looks like a sexually transmitted infection. It can also look like chickenpox, for example. And so there are classic features of monkeypox. We’ve described them many times. There are also some features in this outbreak which make it slightly harder to identify those cases, and there may be new modes of transmission which are as yet not fully described.

00:43:17

So we are calling on all individuals and communities to work together to stop this outbreak, and we’re calling on all scientists and public health authorities as well to work on identifying and learning more about the disease, doing research around the clinical manifestations of the illness, the way it plays out also, the best treatments, which may or may not include antivirals. There are many ways to protect vision, to protect the skin, to prevent complications and long-term sequalae of this disease.

So there is a lot of work to be done, but foremost and primarily understanding what causes risk, what are the situations in which someone might be exposed, and reducing those situations that put people at risk so they can protect themselves. This is how we will get to the end of this outbreak.

CL          Thank you very much. And Dr Mike Ryan, please.

MR         And just on the specifics of risks, there are two specific risks here. One is we don’t wish to see this version of the disease establish itself along with other diseases that have become established, infections that are transmitted sexually and it becomes an established disease, endemic disease, and that’s regardless of sexual preference or gender in that situation.

00:44:46

And we all know how difficult it has been historically to deal with diseases like this because of the issue of stigma, the issues around protection of identity. There are so many issues that it is a complex, complex public health issue. You only have to speak to physicians and public health people who work in that to realise how difficult it can be, not from a purely scientific point of view, but from a societal and a cultural point of view, to address the issues there.

The second risk is obviously the extension of that disease out into a broader community and with transmission at a community level. We’ve seen that previously with orthopoxviruses like smallpox that have done that historically over centuries and caused great pain and suffering. That is not what monkeypox does normally, but we need to be cautious. And as Rosamund said, we don’t have a crystal ball, but viruses do evolve.

It’s not something people should be worried about, but it’s something scientists should be concerned about and following, and we will continue to follow that from that specific point of view. And that’s why we say, again, it is so important that we’d use the opportunity to control the disease where it’s at now, but to do that with the community affected, to do that in partnership with the community, and that their leadership and that the support they receive from governments in particular and from other members of society is now absolutely crucial.

It’s absolutely essential that we don’t push this disease away, push this disease under the table and then try to forget about it as if it doesn’t exist, because if we don’t assist the affected community, there is always the chance that this will become a broader and more generalised issue. So the DG has spoken about it before. If nothing else, this is about enlightened self-interest. This is about showing solidarity for the benefit of the people that we’re in partnership with, but ultimately to the benefit of the whole of our society.

00:46:50

CL          Thank you so much. And we have a few more words from Dr Lewis.

RL          Thank you. I’ll just come in with a couple more thoughts on that particular point about the future. And that is that, as mentioned earlier, this disease has been known for many years now. There has been research. There was extensive research in parts of Central and West Africa in the 1980s around the time of smallpox eradication. That research did start to tail off when it was thought that this may not represent, at that time, a major public health risk. And at that time, that was a reasonable conclusion.

Now, 40 years later, we are seeing a different pattern, but it’s also important to appreciate that the countries that have been living with this virus all this time are still living with this virus. They still have zoonotic transmission. They still have exposure in the natural setting. They still have children who are at risk. They still have adolescents who are going into the forest and maybe hunting with family and community members who may be at risk from a virus that is circulating amongst animals. So that’s one thing.

And the second thing is that as this virus spreads in those countries, in those communities, it has been showing a different patterns of transmission over the last few years. In that situation, 20% to 30% are women and girls, and only two thirds to three quarters of the cases are among men and boys.

00:48:17

And so I also say women and girls and boys advisedly because there are children involved as well in those countries, and some of the deaths that have been occurring from monkeypox in those countries have been occurring most commonly either among children or among people who are immune compromised, including those who may not have adequate access to HIV therapy, for example, or who are immune compromised for other reasons, because they’re taking chemotherapeutic agents, other treatments that may suppress their immune system or have other conditions that may suppress their immune system.

So the risk for some countries is much more multi-faceted, and more people are at risk because of the epidemiology and demographics in those specific situations, which has not changed and they will certainly be complicated by the multi-country outbreak, because, of course, they will also be affected by the multi-country outbreak.

So in addition to what they were already dealing with, which is zoonotic transmission and extension of person-to-person or human-to-human transmission, now they are also having to deal with cases related to travel from other countries and travel within the region. And so they’re going to have a very complex picture and a much greater challenge to really identify what the sources of exposure are, what the modes of transmission are, and therefore an even greater challenge, of course, also in accessing diagnostics, vaccines and therapeutics.

00:49:42

And this is the time to not forget about communities in those countries. This is the time to support those countries and to call on all activists as well as community leaders and governments to do what’s necessary to support those countries as well, while we manage the global outbreak at the same time.

CL          Thank you so much, Dr Lewis and all. With this, we are coming to the close of today’s extraordinary press briefing on the update on the report of the second meeting of the IHR Emergency Committee regarding the multi-country outbreak of monkeypox. I thank you all very, very much for joining us this afternoon, evening, morning, whatever it is for you, to hear the latest on this. Again, thank you for your patience, and good to have had you with us. I want to thank the colleagues here too.

A word on what’s to follow now. We will be sending our usual after press briefing remarks with the audio files and, again, Dr Tedros’s remarks, but also with the links to the Emergency Committee report. This is already online, so you can find it already online. You don’t have to wait for our send-out. And also, Dr Tedros’s remarks are already online and the link is out there. The full transcript of this briefing will most likely be posted by Monday only. We’ll get it done as soon as possible. Any follow-up questions, of course, please join us. And otherwise, thank you again, and over to Dr Tedros for closing.

00:51:19

TAG        Yes. Thank you. Thank you, Christian. One of the questions I just would like to address before we close is especially on stigma and discrimination. Stigma and discrimination, first of all, is a violation of human rights, and second, it can undermine our response and our efforts to stop the transmission and bring this outbreak under control.

So because of these two reasons, I think we ask governments/society to fight stigma and discrimination. And we seek your strong commitment to uphold human dignity, human rights so that we can control this outbreak. With monkeypox, the good news is we have the tools, and if we uphold solidarity and, as I said, human rights and dignity, it can be controlled. We can bring it under control, the outbreak of monkeypox.

So with that, I would like to thank the press who have joined us today, and I join Christian in apologising for the delay. We were supposed to start at 3:00, but I hope you understand. And see you next time, and have a nice weekend.

WHO Team
Department of Communications (DCO)