The WHO has ended public health emergency of international concern for mpox: assessment of upside and downside of this decision

Dear Editor,

Mpox is a zoonotic infectious disease caused by the monkeypox virus (MPXV). In 1958, this virus was first discovered in monkey colonies kept in a Danish research facility hence the name was monkeypox¹. But this caused stigmatization and racism, leading to the name change to mpox². Following its initial discovery in 1958, mpox exhibited zoonotic properties in 1970, and the Democratic Republic of the Congo (DRC) documented the initial human case in a juvenile patient³. Consequently, cases of human mpox have been recorded in 11 African nations. After being endemic in Africa for 33 years, the United States reported the first incidence of mpox outside Africa in 2003. In 2017, mpox remerged in Nigeria, marking its return to the African continent⁴. Cases of mpox were recorded in the United Kingdom during the years 2018, 2019, and 2021⁵. The mutation of the mpox virus since 1970 has enhanced virus transmission capacity⁶. The mpox virus, obtained during the 2022 epidemic, showed an unexpected 40 mutations⁷. In July 2022, the World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern (PHEIC)⁸. As of 27 May 2023, the WHO has documented 87 529 confirmed cases and 141 deaths across 111 countries, with a 29% decrease in case numbers in the last 3 weeks compared to the preceding 3 weeks^9,10. And on 11 May 2023, WHO announced that mpox was no longer a PHEIC considering a significant decline in reported cases, no changes in disease severity, and clinical manifestation¹¹. This announcement led the world to a new pace for development, which halted due to several restrictions for mpox being PHEIC. However, this declaration may also cause some negative impacts on different aspects of our society.

People feel relieved after the WHO’s announcement that the mpox outbreak is no longer a PHEIC. This decision has taken when a noticeable reduction in the number of cases of mpox as well as deaths¹¹. They are also the result of an increased ability to detect and isolate individuals infected with mpox. Robust public health efforts have contributed to the containment and prevention of MPXV transmission, which has resulted in these positive outcomes. Additionally, there has been significant development in repositioning smallpox vaccinations to be effective against mpox¹². Due to the discontinuation of the mpox as PHEIC, authorities will lighten some restrictions to prevent the virus from spreading further. Also, this will assist in restoring both regular social functioning and economic activity. It will be beneficial to the travel and tourism industries all around the world. It will also free up healthcare resources to address other public health priorities¹³. It is an encouraging sign that the fight against mpox in the world is progressing. It will reassure the general people that we can control infectious disease outbreaks and give a message of confidence to them. People will have an easier time returning to their regular life, which will help lessen feelings of anxiety and fear. However, we need to remember that the virus is still circulating in some parts of the world, and this declaration also has the potential to impact society and the global healthcare system.

Although this is an advantageous and time-demanding declaration of WHO, the decision may also have negative consequences. A significant apprehension is that this declaration may reduce public awareness and preparedness¹⁴. The PHEIC classification served as an effective tool in increasing awareness of the mpox virus and its associated hazards. However, with the withdrawal, there is a possibility that individuals may experience a decline in their awareness of the virus and its clinical manifestations. The potential consequence of this phenomenon is a decreased likelihood of individuals engaging in preventative measures against infection¹⁵. This lifting of the PHEIC designation may reduce funding and focus on research and development. Due to this, the potential difficulty in developing novel vaccines and treatments for mpox may arise. The possible decrease in surveillance toward monitoring the MPXV mutated strain and associated symptoms may pose challenges in managing the virus in subsequent times. The potential for a resurgence of the mpox outbreak exists if public health measures are not taken. Its withdrawal may pose a challenge in preventing disease. The persistence of the mpox virus in some parts of the globe is a matter of particular concern¹¹. The announcement of the end of the mpox as a PHEIC is desired to bring a favorable outcome. Notwithstanding, this decision may lead to negative consequences. Acknowledging these potential risks and implementing measures to mitigate them is imperative¹⁶.

A big step forward for global health is the proclamation of the end of a PHEIC for an illness like mpox, but it also brings new difficulties. The declaration of the start or end of a pandemic or PHEIC by the WHO entails a binary decision that can have unintended negative impacts on preventive measures. To address this, the WHO should consider implementing a tiered decision-making approach. By assigning emergency levels such as level 1, level 2, level 3, and so on, a more nuanced understanding of the situation can be achieved, allowing for prompt and precise responses and preventive measures. Also, a comprehensive action plan should accompany each emergency level, outlining specific strategies and interventions to implement. This tiered approach and detailed action plans will enable a more effective and targeted response to public health emergencies, ensuring the preservation of global health and mitigation of negative consequences. Maintaining effective surveillance and monitoring systems is essential to controlling the viral spread. Potential risks are assessed and appropriate action taken, such as ongoing data collection, analysis, and collaboration among health authorities, research institutions, and international organizations. Key to addressing any future reappearance of mpox or other emerging diseases is the transition from emergency response to sustained preparedness, which calls for proper resources, infrastructure, and staff in health systems. Governments and international organizations should make R&D investments, encourage innovation, and build up strategic stockpiles of pharmaceuticals, vaccines, and medical equipment.

Accurate information regarding mpox must continue to communicate clearly and consistently, and community involvement promotes trust, readiness, and adherence to public health regulations. Governments and healthcare professionals should prioritize mental health support services, counseling, and measures for resilience to mpox survivors. Platforms for exchanging best practices, lessons learned, and scientific research should be encouraged to increase international collaboration and learning and improve preparedness and response capabilities on a global scale. To reduce socioeconomic effects and guarantee a more inclusive recovery, governments should emphasize economic recovery efforts, offer financial assistance to impacted firms and individuals, and implement targeted social support programs.

Ethical approval

Ethics approval was not required for this Correspondence.

Sources of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contribution

R.S., A.S.M.R., and M.S.: conceptualization, data curation, and writing – original draft; M.A.B. and M.R.I.: supervision, validation, and writing – review and editing. All authors reviewed and approved the final submission.

Conflicts of interest disclosure

The author(s) of this work have nothing to disclose.

Research registration unique identifying number (UIN)

None.

Guarantor

Md. Rabiul Islam, Department of Pharmacy, University of Asia Pacific, 74/A Green Road, Farmgate, Dhaka 1205, Bangladesh.

Data availability statement

Data not available/not applicable.