The last thing you want to hear is that the World Health Organization has declared a public health emergency because of monkeypox. Monkeypox is a disease that can cause a rash on the face, palms, soles of the feet, and genitalia. Men who have sex with men are most at risk. It can be a serious disease with the case fatality rate around 3%, but the vast majority of people recover at home.

The WHO director general overruled a split emergency committee to insist that the loudest alarm bell should be used. We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we don't know enough and which meets the criteria in the international health regulations.

Mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.

How concerned should we be about monkeypox?

To be considered a public health emergency of international concern, a disease has to meet high thresholds. The international spread of disease requires a coordinated global response.

The alarm bell has been rung only for diseases such as H1N1 swine flu, which occur hundreds of a month. Monkeypox has largely been contained and limited to a few African countries since the first human case was found in 1970. The number of cases has gone up in the last few weeks.

The increase in cases and the rapid spread of the virus through sexual contact networks are Dr. Tedros' concerns now. A new research paper on monkeypox cases in 16 countries shows that 98% of the people were gay or bisexual, 75% of them were white, and 40% had HIV. Most of the cases were thought to be related to sexual transmission. Men who have sex with men need to be the focus of the public health response to contain spread.

Some have suggested that it is homophobic to point out that MSM are the group at highest risk, while others have said that it is not doing anything about it. When tackling infectious diseases, it is standard to identify which groups are most at risk and offer support to reduce the negative impact the disease can have. Some of the highest-risk groups for illness and death from flu are pregnant or older. This is a disease that can easily be spread beyond the MSM community because of its usual transmission pattern.

The current public health emergencies being tracked by the World Health Organization are Covid-19 and polio. We have an effective vaccine that has been approved for the prevention of monkeypox. Availability is limited in the UK. Ensuring adequate supply and access to all who need it is an important part of the response to monkeypox. To raise awareness about symptoms and testing, there needs to be clear messaging and support for those who need to take time off.

The HIV response has shown that telling people not to have sex doesn't work. It is more efficient to show how to protect yourself.

Public health leaders don't want to cry wolf as fatigue sets in after years of the Covid-19 Pandemic. This is a true global emergency according to the WHO. It is time for governments to step up their response. It won't involve lockdowns or restrictions, but it will involve screening, testing, provision of self-isolation support, and outreach to the most at-risk groups.

West African countries have been dealing with monkeypox for a long time. The disease was allowed to spread there without much investment or provision of vaccine, drawing little attention from rich countries. Monkeypox reminds us that a disease is only a plane ride away, and that bugs don't respect national boundaries, even if they are close to us. If a fire rages in your neighbour's garden, the imperative is to help them put it out, because the history of humankind shows that the best approach is collective. It could be your house on fire if you do that.

  • The University of Edinburgh has a chair in public health.

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