Public Health Responses: A Matter of Reality

Public health responses are most effective when rooted in reality, especially when addressing an 'emergency' that involves the transfer of large amounts of public money. The reallocation of resources has a cost, as funds are taken from another program. If the response involves purchasing large quantities of products from a manufacturer, the company and its investors will also benefit.

Three Requirements for Good Practice

There are three key requirements to ensure good practice: 1. Accurate and contextual information is needed. 2. Financial beneficiaries should have no role in decision-making. 3. The organization coordinating the response must act transparently, weighing costs and benefits publicly.

WHO's Declaration of Mpox as an International Emergency

The World Health Organization (WHO), tasked with coordinating international public health, has declared Mpox (monkeypox) an international emergency. They consider an outbreak in the Democratic Republic of Congo (DRC) and nearby Central African countries as a global threat requiring an urgent global response. The WHO stated there were 537 deaths among 15,600 suspected cases this year.

Understanding Mpox

Mpox is endemic to central and west Africa, found in species of squirrels, rats, and other rodents. It has probably been around for thousands of years, causing intermittent infections in humans spread by close physical contact. Small outbreaks in Africa mostly went unnoticed by the rest of the world, mainly because they were small and confined.

WHO's Fast-Track Vaccines for Mpox

The WHO's announcement that 5,000 (or less) suspected Mpox cases is a Public Health Emergency of International Concern (PHEIC) allows it to fast-track vaccines through its Emergency Use Listing (EUL) program, bypassing the normal rigor required to approve such pharmaceuticals.

Confirmed Cases and Deaths

In the past 2.5 years, the WHO has confirmed 223 deaths in the whole world, with just six in July 2024. Note here that 223 deaths are just 0.2% of the 102,997 confirmed cases. They are influenza-like mortality rates, not Ebola-like.

Why Declare an International Emergency?

Why has the WHO declared an international emergency? Some claim it helps mobilize resources. However, an outbreak that is killing a tiny fraction of malaria (or tuberculosis, or HIV) deaths, and far less than those currently dying in war, may not be an international emergency.

What Should Be Done?

Diverting resources from DRC’s major priorities would undoubtedly kill far more than are currently dying from Mpox. It is quite probable that direct adverse events from vaccination alone will kill more than the 19 DRC Mpox victims confirmed this year. Perhaps a useful response would be to improve immune competence through nutrition, providing very broad benefits.

Bottom Line

The number of Mpox deaths will rise as more are infected, and perhaps as some suspected cases are confirmed. However, we are facing a small problem in an area with far larger ones. It is posing low local risk and minimal global risk. It is not a global emergency, by any sane, rational, public health-based definition. The rest of the world can respond by sending vaccines and lots of foreigners who need looking after, diverting local health and security personnel and almost certainly killing more DRC residents overall. Or, we can recognize a local problem, support local responses when local populations ask, and concentrate, as the WHO once did, on addressing the underlying causes of endemic disease and inequality. What do you think about this article? Share it with your friends and sign up for the Daily Briefing, which is every day at 6 pm.