WHO has issued stiff, dual warnings over a surging global rate of COVID infections alongside a still-expanding outbreak of Monkeypox.

The latter is set to be the focus of a discussion by a WHO Emergency Committee meeting Thursday, as the committee reconvenes to decide if a public health emergency should be declared over the virus outbreak, for which WHO has now confirmed almost 14,000 cases – more than double the 6,027 cases that had been reported as of 6 July.

“In the past six weeks, the global weekly number of reported cases of COVID-19 has almost doubled,” Dr Tedros Adhanom Ghebreyesus also said, speaking at a WHO weekly press briefing Wednesday. He spoke on the eve of a second WHO Emergency Committee meeting that was set to convene, once more, to determine if Monkeypox should also be declared, like COVID, as a global health emergency.

“[COVID] deaths are also increasing, but for the moment, not as rapidly as cases. However, more cases means we can expect to see more hospitalizations and bears in the coming weeks. There are many sub lineages of the Omicron variant, most notably BA.5, which is the most transmissible variant detected yet.

“We have said consistently that this virus will continue to evolve and we must be ready for whatever it throws at us. That could be a new version of the variants we already know or something completely new. We know that for any future variant to become widespread, it must be more transmissible than previous variants. But we can’t know how deadly it will be. So all countries must be ready. Countries that have been dismantled some parts of the pandemic response systems are taking a huge risk,” Dr Tedros warned.

World will need new COVID vaccines

While saying that “current vaccines remain highly effective against severe disease and death,” the WHO Director General also acknowledged that “we will need more vaccines that are better at protecting against infection” from the Omicron variant and subvariants of the SARS-CoV2 virus.

But he added that, “if and when we get those vaccines, we cannot afford the same horrific inequity that strained the rollout of vaccines last year.”

His comments signaled a shift in WHO’s stance on COVID vaccine composition.  Until very recently WHO had maintained that the existing vaccines, geared for the original SARS-CoV2 virus, should remain in place – for fear that retooling those vaccines now could interrupt the distribution of supplies that only recently began to reach many low- and middle income countries.

But science and industry have moved ahead – with regulatory authorities like the European Medicines Agency recently stating that they expect to be in a position to approve as early as September a new generation of “bivalent” vaccines developed by pharma manufactuers that also target the Omicron and its variants.

Monkeypox cases in more than 70 countries

In terms of monkeypox, among the nearly 14,000 confirmed cases been reported to WHO until now from more than 70 countries and territories, just five deaths have been reported – all in Africa, said Dr Tedros.

That’s despite the fact that most cases of the disease, previously endemic only in central and west Africa, are now being reported form Europe where the infection transmitted by skin lesions, is be passed primarily among men who have sex with men.

“Although we’re seeing a declining trend in some countries, others are still seeing an increase, and six countries reported their first cases last week,” said Dr Tedros. Although he didn’t specify which countries first saw cases last week, he noted that: “some of these countries have much less access to diagnostics and vaccines, making the outbreak harder to track and harder to stop. WHO is validating, procuring and shipping tests multiple countries and will continue to provide support for expanded access to effective diagnostics.”

Tedros added that in reconvening Thursday, the International Health Regulations Emergency Committee on monkeypox would “review the latest data and to consider whether the outbreak constitutes a Public Health Emergency of International Concern (PHEIC), but “regardless of the committee’s recommendation, WHO will continue to do everything we can to support countries to stop transmission and save lives.

Mixed pattern of transmission in Europe and Africa

Added Rosamund Lewis,  WHO’s technical lead on Monkeypox: “At the moment, we are seeing a very mixed pattern of transmission in some parts of the world, such as parts of Africa, Western Central Africa, but in other countries all around the world 99% of cases reported are among men.

“So it is men who are at risk right now. Not all men,” she added, however, noting that, “98% of those [cases] that are reported are among men who have sex with men, and primarily those who have multiple recent, anonymous or new partners.

“So it’s a question of really understanding what the risk is for an individual, what our individual risk of exposure, the choices we make,” she said.

Awareness-raising among LGBTI communities about prevention, testing and vaccines

She added that WHO is working with representatives of affected communities, and with organizers of pride festivals and celebrations to raise awarenesss:

“These are all important celebrations of identity;  it is also very important that those venues and events and activities share information for people to protect themselves,” she said.

“Coverage of information in some of these events remains patchy.  Some event organizers and tools are sharing this information very broadly. And others may not be. We are urging all health authorities and all community organizers to engage with the affected communities.

“There are ways to protect oneself beyond simply being aware of the risk which is the most important – but also in terms of access to services, access to testing, finding out where tests are available and how they can best be taken, finding out where vaccines possibly may be available, and how they can best be accessed as well.

Added Mike Ryan, WHO executive director of Health Emergencies, “Like we said in COVID, don’t be the person to pass this disease and it doesn’t matter what group you’re in. If you have the lesions, get tested.

“If you can’t get tested, and you suspect that you have monkey pox don’t pass it around,” he said, adding:

“The community that’s currently being infected as one of the most engaged, powerful, responsible communities that we have, who have really worked so hard over many years to contain an even more deadly virus,” referring to HIV/AIDS.

“So we have full confidence that this community can and will engage very closely,” Ryan said.

Understanding of Monkeypox transmission drivers lacking

He added that, “we also need in the broader public health community is to keep an eye on other population subgroups, which we are doing.

“As we’ve said that before…this transmission is occurring and has been occurring in African countries and in particular zones over a large number of years. And we don’t fully understand  what’s driving transmission in those countries and there’s a lot more investigation to do and a lot more investments to be made in understanding that problem.

“Like with COVID, and with other pandemics, we’re destined to repeat these things if we don’t understand their origins, we don’t understand their drivers.

“So we have two jobs to do: We have to work very closely with the community that’s currently affected to ensure that they have the… knowledge to contain this disease, and that we keep an eye on and make sure that other population groups are not affected.

“And we [need to] work with countries that are affected with zoonotic transmission, and onward transmission,” he added, referring to the dozen or so central and west African countries where the disease has circulated for decades among wild animal populations, erupting sporadically in human communities as well, but usually in a more limited way than what is being seen today in Europe and other countries outside of Africa.

“And that’s one of the issues,” stressed Ryan.  “We have patterns of transmission in places like Ghana and Nigeria that actually aren’t purely zoonotic; there is human to human transmission that has occurred that does occur, not explosively, but it does occur in those environments. So we have a lot of knowledge to gain in the coming months. A lot of work to do, and a lot of investment to make both in the communities affected by this disease, but in the science of understanding this.”

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