Geneva, Switzerland · 23 July 2022 — WHO Director-General Dr Tedros Adhanom Ghebreyesus declared the escalating global mpox outbreak a Public Health Emergency of International Concern (PHEIC) on 23 July 2022, overruling a divided Emergency Committee that had failed to reach consensus. The declaration came as cases surpassed 16,000 across 75 countries and territories, with five deaths reported.
The decision was unprecedented in one respect: it was the first time a WHO Director-General had declared a PHEIC against the explicit lack of consensus from the IHR Emergency Committee. At the committee's first meeting on 23 June 2022, when 3,040 cases had been reported from 47 countries, members had resolved by consensus that the outbreak did not constitute a PHEIC. By the second meeting on 21 July, the committee remained split.
The Director-General's Rationale
Under the International Health Regulations (2005), the Director-General is required to consider five elements when deciding whether an outbreak constitutes a PHEIC:
- Information provided by countries — showing rapid spread to countries that had not previously seen the virus
- Three criteria for declaring a PHEIC — which had been met
- Advice of the Emergency Committee — which had not reached consensus
- Scientific principles, evidence, and other relevant information — assessed as currently insufficient
- Risk to human health, international spread, and potential interference with international traffic
WHO's assessment was that the risk of mpox was moderate globally and in all regions, except in the European region where the risk was assessed as high.
"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," said Dr Tedros Adhanom Ghebreyesus. "For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern."
A New Pattern of Transmission
The 2022 outbreak was notable for being the first time mpox spread widely across non-endemic regions. Historically, the virus had been confined to Central and West African countries where it is endemic. The multi-country outbreak demonstrated sustained human-to-human transmission in populations without direct links to endemic countries.
At the time of the declaration, cases were primarily — though not exclusively — identified among men who have sex with men (MSM), particularly those with multiple sexual partners. Dr Tedros emphasised that this concentration meant the outbreak could be stopped with targeted strategies.
"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."
Recommendations for Four Country Groups
The Director-General issued a set of recommendations tailored to four categories of countries:
| Country Group | Key Recommendations |
|---|---|
| Group 1: No cases, or no case for 21+ days | Surveillance, readiness, capacity-building |
| Group 2: Recently imported cases with human-to-human transmission | Coordinated response, community engagement, intensified surveillance, clinical management, accelerate research on vaccines/therapeutics |
| Group 3: Animal-to-human transmission | Strengthen animal-human interface surveillance, prevent spillover |
| Group 4: Manufacturing capacity | Scale up diagnostics, vaccines, and therapeutics production |
The IHR Under Scrutiny
The declaration process itself drew attention to the limitations of the International Health Regulations. Dr Tedros acknowledged that the Emergency Committee's inability to reach consensus highlighted the need for reform.
"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."
Aftermath
The PHEIC declaration galvanised a coordinated international response. Countries intensified surveillance, expanded testing, and began deploying smallpox vaccines — which offer cross-protection against mpox — to at-risk populations. The European Region, bearing the highest case burden, implemented the most aggressive response measures.
WHO ended the PHEIC status on 10 May 2023, as global cases had declined significantly. However, the outbreak underscored the vulnerability of global health systems to emerging infectious diseases and the importance of equitable access to diagnostics, vaccines, and therapeutics — a theme that would recur when a new mpox clade emerged in the Democratic Republic of the Congo in 2024.
Sources
- World Health Organization, "WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern," 23 July 2022.
- World Health Organization, "WHO Director-General's statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox," 23 July 2022.
- PAHO, "Weekly Situation Report: Monkeypox Multi-Country Outbreak Response," 22 July 2022.
- CIDRAP, "WHO declares end to mpox public health emergency," 11 May 2023.
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