World Health Organization director-general Dr. Tedros Adhanom Ghebreyesus declared July 23 that monkeypox is a public health emergency of international concern — the global agency's highest level of alarm — as cases continue to rise steeply in the United States and worldwide.
Public health officials worldwide lauded the declaration, which "can serve to galvanize the international community to more quickly and effectively respond to and combat this virus," the Centers for Disease Control and Prevention said in a statement.
As of July 25, the CDC has identified 3,487 monkeypox cases, with the U.S. tally second only to that of Spain. Worldwide, there are now more than 18,000 cases. The San Francisco Department of Public Health updated its count to 215 the same day. With about one-tenth the population of New York City but one-fifth as many cases, SF might be the epicenter of the U.S. outbreak.
Anyone can get monkeypox. The overwhelming majority of cases in San Francisco, the U.S., and worldwide, however, are among gay, bisexual, trans, and other men who have sex with men, and most are associated with sexual contact. But some experts fear that if the outbreak is not contained, the virus could spread beyond this group. On July 22, CDC director Dr. Rochelle Walensky announced the first two cases in children in the U.S., both attributed to household contact.
The monkeypox virus is transmitted through close physical contact, including skin-to-skin contact, kissing and respiratory droplets at close range, but it does not spread through the air over longer distances. Monkeypox can potentially spread via clothes, bedding or surfaces, but this appears to be much less likely. It is not yet known whether monkeypox is directly sexually transmitted through semen or vaginal fluid, but it does spread via contact with sores during sex.
"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," Tedros said. "That means that this is an outbreak that can be stopped with the right strategies in the right groups."
This entails targeted testing and vaccines for those who need them most, but the U.S. is falling far short. San Francisco has not received nearly enough doses of the new Jynneos vaccine to cover those at highest risk, which includes people who have had close contact with a person with monkeypox, those who have been notified by a venue or event that they might have been exposed, sex workers, and gay and bisexual men and trans people who have had more than one sex partner in the past two weeks.
"LGBT and HIV advocates held a rally July 19 to demand that the federal Department of Health and Human Services increase vaccine allocations. The DPH came under fire at a July 21 San Francisco Board of Supervisors committee meeting for unclear communication about vaccine availability that left people waiting in line for hours. DPH announced late Monday that the drop-in clinic at Zuckerberg San Francisco General Hospital and Trauma Center clinic had given out 550 vaccines that day, but would be closed Tuesday because supplies ran out.
U.S. considers emergency declaration
The WHO previously considered whether to declare monkeypox a public health emergency a month ago, when some 3,000 monkeypox cases had been identified. At that time, an advisory committee agreed that the outbreak did not yet meet the criteria set forth in the WHO's International Health Regulations.
This time, the debate was more contentious. An WHO advisory committee voted 6-9 against a public health emergency designation, but Tedros overrode advisers for the first time ever. Those in favor cited rapidly growing case numbers and warned that without stronger action, the virus could become permanently established in the global population.
Those opposing the declaration noted that monkeypox is not spreading within the general population and has led to just five deaths, all of them in Africa. What's more, some feared a public health emergency designation could further stigmatize men who have sex with men, a particular concern in countries where homosexuality is criminalized.
"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," Tedros said. "Stigma and discrimination can be as dangerous as any virus."
Tedros gave a list of recommendations that include engaging and protecting affected communities; intensifying surveillance and public health measures; strengthening clinical management and infection prevention and control in hospitals and clinics; and accelerating research on vaccines and therapeutics.
While the global designation will likely have little effect in the United States, the Biden administration is considering whether to declare monkeypox a public health emergency, and he plans to appoint a White House monkeypox coordinator, the Washington Post reported. This could lead to increased funding, give the CDC more authority to collect data from states, and improve access to vaccines and the antiviral drug TPOXX (tecovirimat).
"This could allow for all hands on deck to mobilize as big an effort as possible to prevent this from becoming endemic," Jennifer Kates, global health policy lead for the Kaiser Family Foundation, told the Post.
Health officials urge anyone with a rash or other possible monkeypox symptoms to seek medical care and get tested. Those who don't have a regular provider can contact City Clinic on Seventh Street or the San Francisco AIDS Foundation's Magnet sexual health clinic in the Castro. Refrain from sex and other close physical contact until the results are known. People who test positive should avoid close contact until their sores heal completely, which takes about three weeks.
For the latest updates on vaccine eligibility and locations, click here.
To contact City Clinic, click here or call its new phone number, 628-217-6600. To contact SFAF's Magnet clinic at Strut, click here or call 415-581-1600.
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