WHO will reconvene monkeypox Emergency Committee on July 21: What will be recommended?

World Health Organization Director-General Tedros Adhanom Ghebreyesus posted the following on Twitter on July 13:  

“There are now 9,200 #monkeypox cases in 63 countries. The Emergency Committee will reconvene next week and look at trends, how effective the counter-measures are and make recommendations for what countries and communities should do to tackle the outbreak.”  

WHO subsequently announced that the Emergency Committee will meet on July 21. After Dr. Tedros initially convened this committee last month to advise him on whether to declare the international epidemic of monkeypox a Public Health Emergency of International Concern, or PHEIC, he decided it was not a PHEIC. He also said he would reconvene this same Emergency Committee of outside experts if warranted. 

Will a PHEIC declaration be made next week? If so, what official “temporary recommendations” will be issued by WHO as required by the International Health Regulations when a PHEIC is declared?

For some other epidemics, e.g., the 2019 Ebola outbreak in the eastern part of the Democratic Republic of Congo and SARS-CoV-2/COVID-19 in January 2020, WHO declared a PHEIC after earlier deciding not to declare one. 

With other epidemics, however, including Middle East Respiratory Syndrome from 2013-2015 and Yellow Fever in 2016, WHO never declared a PHEIC despite more than one Emergency Committee meeting being convened.

Even if a PHEIC is not declared next week, key recommendations can be issued regarding vaccine(s) for monkeypox and antiviral drugs (e.g., tecovirimat), as well as contact tracing, behavioral risk reduction, effective communication, genomic sequencing and other responses to monkeypox across the 63 countries cited by Dr. Tedros. 

It is hoped that WHO will issue recommendations next week to address issues regarding pre-exposure vaccination, as well as risks of using vaccines, e.g., ACAM2000, that use a replication-competent vaccinia vaccine that, as a result, could cause severe vaccinia disease and be transmitted person to person.

In contrast, the nonreplicating modified vaccinia Ankara virus used in the Bavarian Nordic vaccine (Jynneos) that was approved in 2019 by FDA for monkeypox, as well as smallpox, does not cause disseminated disease or person-to-person transmission.

Time is of the essence for WHO to help lead the global response through its unique ability to (re)convene this Emergency Committee and issue updated recommendations.