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W.H.O. Declares Monkeypox Spread a Global Health Emergency

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For the first time in two years, the World Health Organization has taken extraordinary steps to declare a global emergency. The cause of this time was monkeypox, which spread to dozens of countries in just a few weeks and infected tens of thousands of people.

WHO Secretary Dr. Tedros Adhanom Gebreyes dismissed an advisory group that failed to reach an agreement on Saturday, proclaiming an “international public health emergency.” Illness, Covid-19 and polio.

“There is a rapid outbreak around the world through new modes of infection that we understand too little and meet the criteria,” Dr. Tedros told reporters. It was clearly the first time the Secretary had avoided an adviser and declared an emergency.

The WHO Declaration represents a public health risk that requires a coordinated international response. This designation encourages Member States to invest significant resources in controlling outbreaks, raise more funding in response, and share vaccines, treatments and other important resources to contain outbreaks. can do.

This is the seventh public health emergency since 2007. Of course, Covid’s pandemic was up to date.Some global health experts have criticized WHO’s standards for declaring such emergencies. Opaque and inconsistent..

At a meeting in June, WHO advisers concluded that monkeypox is an increasingly threatening but not yet an international emergency. Dr. Tedros said the panel was unable to reach a decision on Thursday.

“This process once again shows that this important tool needs to be sharpened to be more effective,” he added, referring to the WHO deliberations.

Monkeypox has been a concern in some African countries for years, but in recent weeks the virus has spread around the world. To date, about 75 countries have reported at least 16,000 cases, about five times as many as WHO advisors met in June.

Almost all infectious diseases except Africa occur among men who have sex with men. This outbreak has brought a lot of people in the LGBT community to life. Charged That monkeypox I have not received the Note That’s not surprising, as it happened in the early days of the HIV epidemic.

Dr. Bogma Titanji, an infectious disease doctor at Emory University in Atlanta, said the WHO declaration was “unprecedentedly slow.”

But late, it can be argued that the global response is struggling with the lack of coordination with individual countries working at very different paces to address the issue. “

“There is almost no surrender that the monkeypox virus cannot be stopped from colonizing in a more permanent way,” she added.

Dr. James Roller, co-director of the University of Nebraska’s Global Health Security Center, estimated that it could take more than a year to control the outbreak. By that time, the virus is likely to have infected hundreds of thousands of people and may be permanently established in some countries.

“Unfortunately, I really missed the boat because I was able to cover the outbreak before,” said Dr. Laura. “From now on, it will be really hard to be able to contain and control spreads.”

The longer the outbreak, the more likely it is that the virus will move from the infected person to the animal population, and the virus will persist and can sporadically cause new infections in people. This is one way the disease can become endemic in an area.

As of Saturday, the United States recorded about 3,000 cases, including two children, but the actual casualties are believed to be much higher as the test is currently only scaled up. The UK and Spain each have about the same number of cases, with the rest distributed in about 70 countries.

Many people infected in these countries have not reported known sources of infection and Undetected community spread..

A WHO adviser issued an urgent declaration at the end of June as the disease did not move from a major risk group of men having sex with men to affect pregnant women, children, or the elderly. He said he did not recommend it. Infection increases the risk of serious illness.

Although the virus is spread primarily through close contact, researchers are still assessing the route of transmission in the current outbreak. And in an interview, some experts said they disagreed with the rationale.

“Do you want to declare an emergency in a really terrible moment, or do you want to declare it in advance?” Said Dr. Isabella Eckal, a clinical virologist at the University of Geneva.

“Currently, this problem is not occurring. The virus is not found in children and in pregnant women,” she added. “But I know if I’ll let this go, but if I don’t do enough, it will happen at some point.”

A similar WHO committee convened in early 2020 to assess the outbreak of coronavirus also met twice, and only at the second meeting on 30 January was the virus spread in a public health emergency. I decided to have it.

Committee members Proposed at that time WHO is considering creating an “intermediate level warning” for the occurrence of moderate concerns. As outbreaks become more frequent, organizations may need such a system.

Deforestation, globalization and climate change are increasing the opportunities for pathogens to leap from animals to humans. Today, emerging viruses can pose a global threat across national borders.

However, most public health authorities remain equipped solely to handle chronic illnesses or minor outbreaks.

Tom Inglesby, director of the Johns Hopkins Health and Security Center at the Bloomberg School of Public Health, said Covid’s pandemic devastation and monkeypox surge should warn the government to prepare for a new epidemic without notice. Said that.

“The world is fed up with the crisis of infectious diseases, but they are part of a new normal that will require a lot of continuous attention and resources,” he said. “We need a global vaccine and therapeutic approach to production and stockpiling that does not yet exist.”

Monkeypox has been burning regularly in some African countries for decades. Experts have warned of potential global threats for years, but their warnings have been largely ignored.

Vaccines and drugs are primarily available due to the risk of bioterrorism attacks by smallpox, a closely related species of monkeypox virus.

However, access to a drug called tecovirimat is hampered by time-consuming bureaucracy and government control of supply, delaying treatment by days or weeks in some patients.

The newer and safer dose of Jynneos of the two vaccines available is severely restricted, even in the United States, which helped develop the vaccine.

As of Friday, New York City had recorded 839 cases of monkeypox, almost all of whom were men having sex with men, according to the city’s Ministry of Health. The city started in late June Providing monkeypox vaccineHowever, there was a shortage of about 1,000 doses available.

Since then, supply has grown slowly to about 20,000 doses. The city offered an additional 17,000 initial dose appointments on Friday night, which soon became full.

“Vaccine supply is still low,” the city’s health department said. Website Said on Saturday.

Containing the virus can be even more difficult in countries where the supply of vaccines and treatments is limited or completely absent. Without a global emergency framework, countries would have to find their own ways to provide tests, vaccines and treatments, exacerbating inequality between nations.

Failure to adjust the response also wasted the opportunity to collect data in large multinational studies, especially when disease monitoring tends to be uneven.

“The inability to characterize the epidemiological situation in the region represents a substantial challenge in designing interventions to control this historically neglected disease,” said Dr. Tedros. He mentioned the countries of West Africa and Central Africa. statement On thursday.

For example, cases of monkeypox in Nigeria and the Democratic Republic of the Congo, where the virus is endemic, suggest that a painful systemic rash can develop 1-2 weeks after exposure.

However, many patients who are currently developing have lesions only in the genital area. Some people, especially those who feel pain in the throat, urethra, and rectum, suffer from intolerable pain.

“I was scared to actually use the bathroom,” said one of the recent patients, New York City-based part-time model Gabriel Morales, 27. “I can’t even explain it. It feels like the glass is broken.”

Many other patients experience only mild symptoms, and some do not usually experience the fever, body aches, and respiratory symptoms associated with the disease.

Only severe cases may have been detected in endemic areas of Africa, and current outbreaks provide a more accurate picture of the disease, Dr. Eckal said. Alternatively, the virus itself may have changed significantly, as does the profile of the symptoms it causes.

according to Preliminary genetic analysis Of the samples from infected patients, the monkeypox genome appears to have collected nearly 50 mutations since 2018, more than 6 or 7 expected to accumulate during that period.

It is unknown whether the mutation changed the mode, severity, or other nature of the virus. However, early analysis suggests that monkeypox may have adapted to spread more easily among people than it did before 2018.

Coordinating responses between countries will help address many uncertainties about outbreaks, Dr. Eckal said: “There are so many open questions.”

Joseph Goldstein When Sharon Otterman Contribution report.

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