Kai Kupferschmidt Profile picture
Jun 26 14 tweets 9 min read
I think yesterday’s decision not to declare the ongoing #monkeypox outbreak a public health emergency of international concern (PHEIC) raises some interesting questions.
So a brief thread:
When is something a PHEIC?
The International Health Regulations say it is an "extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response"
You can boil it down to 3 criteria:
- extraordinary event
- risk of international spread
- may require a coordinated response

International spread is clearly given, and the committee itself noted "the response to the outbreak requires collaborative international efforts"
That leaves the question of whether this is an “extraordinary event”. That question is tricky, in part because monkeypox outbreaks in Africa have largely been ignored by the world in the past. Is it extraordinary now simply because it is spreading in high income countries?
As @alexandraphelan told me:
"It is unjust and unethical to determine an event is only extraordinary if it is now occurring in high income countries, but rather than not declare a PHEIC, it underpins how the current criteria are not appropriately tailored"
@alexandraphelan As @Boghuma told me:
It's not just that it is spreading in different countries, "but because it is spreading in a very different way to how it has spread in the past and we have very limited supply on the tools needed to address the problem"
@alexandraphelan @Boghuma The criteria were clearly met, @gregggonsalves who advised the committee told me: “I think they made a big mistake. They punted.”
"It feels again like a missed opportunity to focus much needed attention on the current situation”, says @Boghuma.
@alexandraphelan @Boghuma @gregggonsalves It’s worth remembering that we have been here before:
@alexandraphelan @Boghuma @gregggonsalves On 22 and 23 January 2020 an Emergency Committee met to decide whether Covid-19 should be declared a PHEIC.
The EC did not reach consensus with some members feeling it was too early. Many researchers criticised this.
The EC reconvened one week later and declared a PHEIC.
@alexandraphelan @Boghuma @gregggonsalves On 14 June 2019 an EC met for the fourth time to decide whether an Ebola outbreak in the DRC constituted a PHEIC. The committee said it was "a health emergency in the DRC and the region", but not a PHEIC.
The EC reconvened a month later and declared a PHEIC.
@alexandraphelan @Boghuma @gregggonsalves To me personally, yesterday’s decision feels a lot like these two decisions. It seems like a delay of the inevitable (though I might be proven wrong on this of course).

It raises the question of what exactly a PHEIC is meant to accomplish.
@alexandraphelan @Boghuma @gregggonsalves The EC noted a whole list of bad scenarios that would justify reconsidering the decision.
It seems to me that if these are scenarios that seem likely, then calling something a PHEIC might be an attempt to avoid these scenarios from becoming reality.
@alexandraphelan @Boghuma @gregggonsalves So I’m left with this question:
Is a PHEIC simply a retrospective label of something that is clearly really bad?
Or is it also an instrument to avoid the worst outcomes by calling attention to a problem earlier?

I'm not sure there is a clear answer to this at the moment...
Story is here by the way: science.org/content/articl…

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More from @kakape

Jun 25
Finally had a chance to read @UKHSA’s second technical briefing on #monkeypox.

It mostly reaffirms what we already knew or kind of knew. So just a quick thread.
Entire report is here:
gov.uk/government/pub…
@UKHSA There were 846 confirmed cases up to 22 June.

The vast majority (99%) continues to be in men:
Of 810 confirmed cases with gender information:
- 805 were male
- 5 were female

Here is a striking graph (not including all cases): Image
@UKHSA 321 patients answered detailed questionnaires. As you can see from the table, 96% were "gay, bisexual, or men who have sex with men (GBMSM) strongly suggesting transmission in defined sexual networks, both internationally and domestically” Image
Read 7 tweets
Jun 20
I wrote a piece about why monkeypox might suddenly be spreading in countries that have never seen a large outbreak before and what role sexual networks might play.

Story is here (and a thread to come):

science.org/content/articl…
Caveats first:
At the moment monkeypox cases in non-endemic countries are mostly reported among men who have sex with men (MSM). But that could be driven in part by differences in health-seeking behavior.
I‘m a gay man living with HIV man and I go for a check-up every three months. Many MSM take Prep and have similar check-ups. As Lilith Whittles told me: „MSM have a better relationship with medical practitioners than heterosexual men”
Read 27 tweets
Jun 15
Sorry, aber das hier von @dpa (hier via @SZ) ist übelste Misinformation zu Affenpocken und in jeder Hinsicht katastrophale Kommunikation:
1. Das RKI schreibt ganz explizit für Patienten: "Das Tragen von Kondomen allein schützt in dieser Phase nicht vor Infektion." Image
@dpa @SZ 2. Dürfte bei den meisten Menschen beim Sex die Schleimhaut des Penis nicht die einzige Schleimhaut sein, die mit dem oder den Anderen in Kontakt kommt.
@dpa @SZ 3. Wissen wir bislang nicht einmal mit Sicherheit ob das Virus überhaupt über Sperma übertragen wird. Das ist möglich, aber noch unklar.
Klar ist aber, dass das Virus durch Haut-zu-Haut-Kontakt übertragen wird. In dieser Situation allein auf Kondome zu setzen ist Unsinn.
Read 5 tweets
Jun 13
104 additional monkeypox cases reported in the UK since last update on Friday, according to @UKHSA.
That brings the total to 470 cases.
"There are currently 452 confirmed cases in England, 12 in Scotland, 2 in Northern Ireland and 4 in Wales."

gov.uk/government/new…
@UKHSA Worth remembering that there is a significant lag in reporting, as @UKHSA noted ion Friday:

"The median reporting delay, calculated here as the time between symptom onset date and date notified to UKHSA, was 10 days for cases newly reported in the week starting 6 June 2022."
@UKHSA As it happens, the best guess for the serial interval is also about 10 days:

"Preliminary estimate of the serial interval is 9.8 days though with high uncertainty (95% credible interval, 5.9 to 21.4).”
Read 5 tweets
Jun 8
The good news is: we have vaccines that can help prevent monkeypox.
The bad news is: We’re still figuring out how effective they are, how much is available and how best to use them.
So a thread about monkeypox and vaccines.
My story is here:

science.org/content/articl…
First of all: While monkeypox has caused disease and death in Central and West Africa for decades and cases have steadily increased for many years, no vaccines have ever been specifically developed to prevent monkeypox. What we are really talking about are smallpox vaccines.
So give smallpox vaccines to everyone and we’re done?
Well, guess what? It’s complicated.
So let’s look at safety, efficacy, supply and then strategies (unless I run out of steam or people who actually pay me for my work call me in the middle of this)
Read 36 tweets
Jun 5
New update from @WHO on #monkeypox is out:

780 confirmed cases now from
27 non-endemic countries
(Last week it was 257 cases in 23 countries)
No deaths so far

who.int/emergencies/di…
@WHO "Apart from patients hospitalized for the purpose of isolation, few hospitalizations have been reported.
Complications leading to hospitalization have included the need to provide adequate pain management and the need to treat secondary infections."
@WHO And here is the situation in #monkeypox endemic countries at the moment.
Cameroon and Nigeria are the two countries currently reporting cases of the West African clade, the clade that has also been identified in cases in non-endemic countries
Read 8 tweets

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