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August 10, 2022
2022 Multicountry Outbreak of Monkeypox
Introduction
Global Control Efforts
In May 2022, the International Health Regulations (IHR)
The IHR Emergency Committee on monkeypox, which
Focal Point for the United Kingdom notified the World
advises the WHO Director-General on declaring a PHEIC,
Health Organization (WHO) that an individual who
met twice to discuss the outbreak: in June, when there were
travelled from the United Kingdom to Nigeria had a
more than 3,000 cases in 47 countries, and in July, when
confirmed case of monkeypox. The disease has since spread
there were more than 16,000 cases in 75 countries. The
to more than 75 countries and territories; as of August 5, the
committee determined at the first meeting that the event
U.S. Centers for Disease Control and Prevention (CDC)
was not a PHEIC and could not reach a consensus on the
reported more than 28,000 cases worldwide. Almost 90% of
matter at the second meeting. For more on IHR and PHEIC,
the reported cases were from 10 countries: the United States
see CRS In Focus IF12139, U.S. Proposals to Amend the
(27%), Spain (18%), Germany (10%), the United Kingdom
International Health Regulations.
(10%), France (9%), Brazil (5%), the Netherlands (3%),
Canada (3%), Portugal (3%), and Italy (2%). All related
On July 23, 2022, WHO Director-General Tedros
deaths have occurred in Nigeria (3) and Central African
Ghebreyesus determined the monkeypox outbreak was a
Republic (2). In July, several Members of Congress sent
PHEIC, noting, “Although I am declaring a public health
letters to President Biden urging his Administration to
emergency of international concern, for the moment this is
declare a Public Health Emergency (PHE) and to accelerate
an outbreak that is concentrated among men who have sex
the federal response to the outbreak. The WHO Director-
with men, especially those with multiple sexual partners.
General declared monkeypox a Public Health Emergency of
That means that this is an outbreak that can be stopped with
International Concern (PHEIC) on July 23, 2022, and U.S.
the right strategies in the right groups. It’s therefore
Department of Health and Human Services (HHS)
essential that all countries work closely with communities
Secretary Xavier Becerra declared the outbreak a PHE on
of men who have sex with men, to design and deliver
August 4, 2022. For more on the domestic response, see
effective information and services, and to adopt measures
CRS In Focus IF12186, U.S. Domestic Response to the
that protect the health, human rights and dignity of affected
2022 Monkeypox Outbreak.
communities.”
Monkeypox Discovery and Transmission The Director-General provided a number of
recommendations to stop transmission, including (1)
Monkeypox is a viral zoonosis (a virus transmitted to
engage and protect affected communities; (2) intensify
humans from animals) from the same family of viruses that
surveillance and public health measures; (3) strengthen
cause smallpox and carry similar symptoms, including
clinical management and infection prevention and control
fever, swelling of the lymph nodes, fatigue, muscle aches,
in hospitals and clinics; and (4) accelerate research into the
rashes, and lesions. The symptoms usually resolve on their
use of vaccines, therapeutics, and other tools.
own after two to four weeks. Severity varies according to
age, extent of virus exposure, and patient health status. The
Control Efforts in Europe
disease is transmitted from one person to another by close
As of August 5, monkeypox transmission was highest in
contact with lesions, body fluids, respiratory droplets, or
Spain (4,942 cases), Germany (2,887), the United Kingdom
contaminated materials, such as bedding.
(2,859), France (2,423), Netherlands (879), Portugal (710),
and Italy (545). These countries deployed similar mitigation
The name monkeypox originates from its discovery in
measures, including contact tracing, testing, provision of
monkeys in a Danish laboratory in 1958. The first human
interim guidelines for curbing community transmission, and
case was identified in a child in the Democratic Republic of
vaccine rollouts for susceptible groups. On June 14, 2022,
the Congo in 1970. Various animal species are susceptible
the European Commission announced that it had, for the
to the monkeypox virus, though scientists are uncertain
first time, used the European Union (EU) budget to
about the origin of the virus and how its circulation is
purchase almost 110,000 vaccines for monkeypox control
maintained in nature. Eating undercooked meat and other
in the EU, Norway, and Iceland. The vaccines are
animal products of infected animals is a possible risk factor.
authorized to protect adults against smallpox, but Member
Until the current global outbreak began, monkeypox was
States are granting national exemptions for their use against
generally limited (endemic) to West and Central Africa (as
monkeypox.
outlined in red in Figure 1). The identification of cases
Control Efforts in the United States
without any travel history to endemic areas is
unprecedented. With the exception of countries in West and
On June 28, 2022, the White House announced the first
Central Africa, the ongoing outbreak is primarily occurring
phase of the national monkeypox vaccine strategy. The
among men who have sex with men (MSM) with multiple
strategy, along with other parts of the national response,
sexual partners.
will be coordinated by the National Security Council
https://crsreports.congress.gov
2022 Multicountry Outbreak of Monkeypox
Directorate on Global Health Security and Biodefense
international need, upon request by WHO. In 2002, the
(White House Pandemic Office). The national response
World Health Assembly adopted Resolution 55.16, calling
focuses on expanding access to diagnostic tests and
for the reinforcement of stockpile resources for future
accelerating the production and distribution of vaccines. As
PHEICs. Last updated in 2017, the WHO operational
of August 5, U.S.-reported monkeypox cases reached 7,510,
framework outlines conditions for tapping the SVES. Given
with 84% reported in a dozen states: New York (1,862),
that smallpox vaccines are effective against monkeypox and
California (826), Florida (633), Texas (606), Illinois (602),
that WHO has declared the ongoing global monkeypox
Georgia (596), the District of Columbia (283),
outbreak to be a PHEIC, several countries have announced
Pennsylvania (205), New Jersey (188), Maryland (182)
plans to draw from their national stockpiles. It is unclear the
Washington (175), and Massachusetts (157). The Biden
extent to which they are following the SVES guidelines.
Administration has committed to controlling monkeypox
worldwide through technical assistance and funding, as
Issues for Congress to Consider
previous administrations had during earlier monkeypox
On July 26, 2022, U.S. Representative Ritchie Torres
outbreaks in Nigeria and the Democratic Republic of Congo
introduced H.Res. 1286, Expressing the Sentiment of
(DRC).
Congress that the Department of Health and Human
Global Vaccine Access Issues
Services should declare the monkeypox outbreak a public
health emergency. Among other things, the resolution
Some observers are urging manufacturers to ensure that
called for the federal government to accelerate the use of all
countries in Africa, where the disease has been endemic for
available tools to mitigate the spread of the virus. Now that
decades, have access to vaccines that may be used for
the HHS Secretary has made a PHE declaration, HHS may
smallpox and monkeypox control should they need it.
access appropriations to the Public Health Emergency Fund
Others point out that most countries on the continent have
for monkeypox control. Should Congress provide additional
not reported any cases and that only Nigeria and
funds, Members may debate the appropriate balance of
Democratic Republic of the Congo have reported more than
resources in domestic and international settings.
a dozen cases, 101 and 131 cases, respectively.
The Danish biotech company Bavarian Nordic is the
Health experts are also debating the prudent use of
primary manufacturer of smallpox and monkeypox
stockpiled vaccines. In 1980, WHO established the
vaccines. With the EU, the United States, and other
Smallpox Vaccine Emergency Stockpile (SVES) to ensure
undisclosed countries placing bulk orders with the
the “vaccine could be rapidly deployed and administered in
company, some observers are concerned about the capacity
response to any future outbreaks.” WHO is responsible for
of low- and middle-income countries (LMIC) to access
maintaining capacity and expertise to respond to a
doses. Given that the outbreak remains primarily
reemergence of smallpox and for preserving a stockpile at
concentrated in affluent countries, Congress may consider
WHO headquarters in Switzerland. The bulk of the
how ongoing global health security efforts could be
stockpile, however, is held by donor countries (France,
leveraged to prevent further spread to LMIC.
Germany, Japan, New Zealand, and the United States) in
their respective national stockpiles for use in time of
Airi Price, a CRS summer intern, contributed to this In
Focus.
Figure 1. Monkeypox Cases Reported Worldwide
(as of August 5, 2022)
Source: Created by CRS from CDC, 2022 Global Map & Case Count, accessed on August 5, 2022.
Tiaji Salaam-Blyther, Acting Section Research Manager
https://crsreports.congress.gov
2022 Multicountry Outbreak of Monkeypox
IF12191
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