The Director General of the WHO declares the measles outbreak a public health emergency of international concern

WHO Director-General Dr Tedros Adhanom Ghebreyesus has identified the rise of measles in the Democratic Republic of Congo (DRC) and a growing number of countries in Africa as a Public Health Urgent International Concern (PHEIC) under the International Health Regulations (2005) (IHR).

Dr Tedros' statement came on the advice of the IHR's emergency committee of independent experts who met earlier in the day to review data presented by experts from WHO and affected countries. The committee informed the CEO that it considers the outbreak of smallpox to be a PHEIC, with the possibility of further spread to countries in Africa and possibly beyond the continent.

The Director-General will share the report of the Committee meeting and, based on the Committee's advice, issue interim recommendations to countries.

Announcing the PHEIC, Dr Tedros said: “The emergence of a new class of mppox, its rapid spread in eastern DRC and the reporting of cases in several neighboring countries are of great concern. On top of the outbreaks of other classes of mppox in the DRC and other countries in Africa, it is clear is that a coordinated international response is needed to stop these epidemics and save lives.”

WHO Regional Director for Africa Dr Matshidiso Moeti said: “Significant efforts are already underway in close collaboration with communities and governments, and our country teams are working on the front lines to help strengthen measles control measures. As the spread of the virus continues to spread, we are scaling up further through coordinated international action to support countries to bring an end to the epidemic.”

The chairperson of the committee, Professor Dimie Ogoina, said: “The current increase in smallpox in parts of Africa, together with the spread of a new sexually transmitted strain of the monkeypox virus, is an emergency, not only for Africa, but for the whole world. Mpox, originating in Africa, was neglected there and later caused a global epidemic in 2022. It is time for decisive action to prevent history from repeating itself.”

This PHEIC determination is the second in two years related to mpox. Caused by Orthopoxvirus, mpox was first discovered in humans in 1970 in the DRC. The disease is considered endemic to Central and West African countries.

In July 2022, a multi-country outbreak of mppox was declared a PHEIC because it was spreading rapidly through sexual contact in a number of countries where the virus had not been seen before. That PHEIC was declared complete in May 2023 following a continued decline in global cases.

Mpox has been reported in the DRC for more than a decade, and the number of reported cases has steadily increased each year during this period. Last year, the number of reported cases increased significantly, and the number of reported cases this year has already exceeded last year's total, with more than 15,600 cases and 537 deaths.

Last year's emergence and rapid spread of a new strain of the virus in DR Congo, clade 1b, which seems to spread mainly through sexual networks, and its detection in countries neighboring DR Congo are of particular concern and one of the main reasons for declaring PHEIC.

In the past month, more than 100 laboratory-confirmed cases of clade 1b have been reported in four countries neighboring the DRC that have not previously reported mpox: Burundi, Kenya, Rwanda and Uganda. Experts believe that the true number of cases is higher because a large proportion of clinically compatible cases have not been investigated.

There have been several outbreaks of different types of smallpox in different countries, with different modes of transmission and different levels of risk.

The two vaccines currently in use for measles are recommended by the WHO's Strategic Advisory Group of Experts on Immunization and have been approved by national regulatory authorities on the WHO's list, as well as by individual countries, including Nigeria and Congo.

Last week, the director-general launched an emergency list process for pain vaccines, which will speed up access to the vaccine for lower-income countries that have not yet issued their own national regulatory approval. The emergency list also allows partners, including Gavi and UNICEF, to procure vaccines for distribution.

WHO is working with countries and vaccine manufacturers on potential vaccine donations and is coordinating with partners through the Interim Medical Countermeasures Network to enable equitable access to vaccines, therapies, diagnostics and other tools.

WHO anticipates an immediate funding need of an initial US$15 million to support surveillance, preparedness and response activities. The assessment of needs is carried out at three levels of the Organization.

To enable the immediate increase, WHO has released US$1.45 million from the WHO Emergency Fund and may need to release more in the coming days. The organization is appealing to donors to fund the full scope of measles response needs.