It can be stopped with the right strategies in the right groups
In late July 2022, the World Health Organization issued its highest possible alert as monkeypox spread to nearly 17,000 people across 74 countries — a threshold crossed not by consensus, but by the solitary judgment of its director-general. The outbreak, long familiar to parts of Africa, had found new momentum in a specific community, raising not only epidemiological concern but the older, more stubborn danger of stigma. As a repurposed smallpox vaccine moved toward approval, the WHO's declaration carried a dual message: the crisis was serious, but it was also, with care and solidarity, containable.
- A WHO director-general overruled his own divided advisory committee to declare monkeypox a global health emergency — the organization's most urgent designation.
- Nearly 17,000 infections across 74 countries in just months marked a sharp departure from the virus's historical confinement to West and Central Africa.
- With 95% of transmission occurring through sexual contact among men who have sex with men, the outbreak's concentration raised fears of scapegoating alongside fears of spread.
- The EU's drug regulator moved to approve Imvanex — a smallpox vaccine with structural cross-protection — offering a concrete intervention just as the emergency was declared.
- WHO leadership called explicitly for community partnership over top-down mandates, insisting that the populations most affected must help design the response aimed at protecting them.
On a Saturday in late July, WHO Director-General Tedros Adhanom Ghebreyesus made a decision his own expert committee could not: he declared monkeypox a public health emergency of international concern. With nearly 17,000 cases across 74 countries, the outbreak had outgrown the regions of West and Central Africa where the virus had long circulated quietly. Europe faced the sharpest risk, and the pace of spread was accelerating.
The data told a precise story. A landmark study tracking 528 patients across 16 countries found that 95 percent of transmission had occurred through sexual contact, with 98 percent of those infected identifying as gay or bisexual men. The concentration was epidemiologically significant — but Ghebreyesus understood it was also socially volatile. He named the pattern plainly while insisting it pointed toward a solution rather than a scapegoat: targeted, community-led strategies could interrupt transmission if deployed with respect and partnership.
A day before the declaration, the EU recommended approval of Imvanex, a smallpox vaccine developed by Bavarian Nordic that carries protective value against monkeypox due to the viruses' shared structure. It offered a practical tool to match the political will the WHO was now demanding. The emergency declaration was not a counsel of despair — it was a call to act with both urgency and conscience, before a medical crisis hardened into a social one.
On a Saturday in late July, the World Health Organization sounded its loudest alarm. Tedros Adhanom Ghebreyesus, the organization's director-general, stood before cameras and declared the monkeypox outbreak a public health emergency of international concern—the highest alert the WHO can issue. Nearly 17,000 people across 74 countries had been infected. The decision did not come easily. A committee of expert advisors had convened just days earlier and failed to reach consensus on whether the outbreak warranted such an extreme measure. That disagreement left the choice to Ghebreyesus himself.
The monkeypox virus, a relative of the now-eradicated smallpox, had been known to circulate in West and Central Africa for decades. But something shifted in early May. Cases began appearing outside those endemic regions at an accelerating pace, spreading across Europe, North America, and beyond. By the time the WHO made its declaration, the European region faced particularly acute risk, while other parts of the world registered moderate concern. The virus itself is less lethal and less transmissible than its smallpox cousin, but it was moving fast through a specific population: men who have sex with men. Data from the largest study to date, which tracked 528 infected people across 16 countries and was published in the New England Journal of Medicine, showed that 95 percent of transmission had occurred through sexual contact. Overall, 98 percent of those infected identified as gay or bisexual men, and roughly a third had visited sex-on-site venues—bathhouses, sex parties, saunas—in the month before falling ill.
Ghebreyesus had worried aloud about stigma from the start. The concentration of cases in one community created a risk that went beyond epidemiology: the danger of scapegoating, of turning a public health crisis into a social one. On Saturday, he named the pattern directly. The outbreak was "concentrated among men who have sex with men, especially those with multiple sexual partners," he said, but that concentration also meant something crucial—it could be stopped. The right strategies, deployed in the right communities, could work. He called on every country to partner closely with gay and bisexual men's communities, to design information and services alongside them rather than at them, and to adopt protections for the people most affected.
A potential tool had just emerged. On Friday, the European Union's drug regulator recommended approval of Imvanex, a vaccine originally developed to prevent smallpox. The Danish pharmaceutical company Bavarian Nordic had created it, and the EU had authorized it for smallpox prevention since 2013. Because monkeypox and smallpox viruses share structural similarities, Imvanex offered a pathway to vaccination. The first signs of monkeypox infection—fever, headache, muscle and back pain—typically appear over five days, followed by a distinctive rash on the face, palms, and soles of the feet. Lesions, pustules, and eventually scabs follow. Early intervention with a vaccine could interrupt that progression.
The WHO's emergency declaration was not a statement that the world was helpless. It was a statement that the world needed to act with intention and speed, and that it needed to do so without turning a medical crisis into a moral one. The numbers were stark: 17,000 people infected, 74 countries affected. But the path forward was clear, if the world chose to walk it.
Citas Notables
The global monkeypox outbreak represents a public health emergency of international concern— Tedros Adhanom Ghebreyesus, WHO director-general
The outbreak can be stopped with the right strategies deployed in the right groups, requiring countries to work closely with men who have sex with men to design and deliver effective information and services— Tedros Adhanom Ghebreyesus
La Conversación del Hearth Otra perspectiva de la historia
Why did the WHO's expert committee split on this decision?
The situation was moving fast. When they first met in June, case numbers hadn't yet reached the threshold they typically use to declare an emergency. By Thursday, when they reconvened, the numbers had climbed significantly. But even then, there wasn't agreement. Ghebreyesus had to make the call himself.
What made him decide to declare it?
The trajectory. Cases were doubling, spreading to new countries, and the concentration in one community meant it could either be contained quickly with the right approach, or it could become much harder to track. He was worried about both the medical reality and the social one.
You mean the stigma?
Exactly. If people in affected communities felt blamed or hunted, they'd stop getting tested, stop seeking care, stop being honest with contact tracers. The virus would move underground. He said that explicitly—that stigma could make the outbreak harder to control.
So the emergency declaration was partly about forcing countries to engage respectfully?
It was about saying: this is serious enough that you have to act. And here's how you act—by working with the communities involved, not against them. The vaccine exists now. But a vaccine only works if people trust the system offering it.
Did declaring it an emergency actually change anything on the ground?
It changed the political weight. It meant funding could move faster, countries had to report cases, and the world was watching. Whether that translated to better community engagement—that depended on what each country actually did with the declaration.