PRESS BRIEFING BY THE UNITED NATIONS INFORMATION SERVICE

20 August 2024

Preparations for Potential Mpox Outbreak in Europe

Tarik Jašarević for the World Health Organization (WHO) said that yesterday, the WHO Director-General issued temporary recommendations on mpox. These recommendations were primarily for countries experiencing an outbreak but also for countries preparing for a potential outbreak.

Dr Hans Klug, Regional Director for Europe, World Health Organization (WHO), said the world was tackling mpox as a Public Health Emergency of International Concern for the second time in two years. However, mpox was not the “new COVID”. Behind the ongoing outbreak in east-central Africa of mpox clade II, mpox had continued to circulate in Europe since the 2022 outbreak that initially impacted the region.

Specialists knew quite a lot about clade II already. There was still more to learn about clade I. Mpox primarily transmitted through skin-to-skin contact with mpox lesions, including during sex.

WHO knew how to control mpox and the steps needed to eliminate its transmission altogether in the European region. Two years ago, it controlled mpox in Europe thanks to direct engagement with the most affected communities of men who have sex with men. It put in place robust surveillance; thoroughly investigated new cases contacts; and provided sound public health advice. Behaviour change, non-discriminatory public health action, and mpox vaccination contributed to controlling the outbreak.

Learning from this success, WHO had urged Governments and health authorities to sustain those measures to help eliminate mpox from Europe. But through a lack of commitment and a lack of resources, Europe had failed to go the last mile. Today, there were about 100 new mpox clade II cases in the European region every month.

However, the current state of alert due to clade I gave Europe the opportunity to refocus on clade II to strengthen mpox surveillance and diagnostics. Governments needed to issue public health advice, including to travellers, grounded in science – not in fear, not using stigma, and not through discrimination. They needed to procure vaccines and antivirals for those who may need them – based on strategic risk assessments.

While strengthening vigilance against mpox clade I, European nations could – and should – strive to eliminate clade II in Europe for once and for all.

The need for a coordinated response was now greatest in the African region. The Africa Centres for Disease Control and Prevention declared an mpox continental emergency shortly before WHO’s global declaration.

Europe needed to choose to act in solidarity. Solidarity with individuals and communities impacted by mpox – by working directly with them to take charge of their own health. And solidarity with the WHO African Region and its affected Member States - both at this critical time and in the long term.

In 2022, mpox showed that it could spread quickly around the world. We needed to put the systems in place to tackle mpox together across regions and continents. If we failed to do so, we would enter another cycle of panic, then neglect. How we responded now, and in the years to come, would prove a critical test for Europe and the world.

In response to questions, Dr Klug said there was a risk that European countries could stockpile vaccines for themselves. The global community needed to learn from the experience of the COVID-19 pandemic. It was promising that the European Commission's Health Emergency Preparedness and Response Authority (HERA) was already donating vaccines, and that Belgium had strongly committed to donating vaccines. The challenge would be securing vaccines if the need for them in Europe increased. WHO was in contact with staff and partners in Africa, working to strengthen solidarity between Europe and Africa. This was a litmus test for global solidarity.

The public health advice of the last two years in the European region was still in place. The most prevalent form of mpox in Europe was still clade II, which was transmitted through close skin-to-skin contact, including through sex between men. It remained important to inform persons in high-risk communities and avoid stigma and discrimination.

Persons with blisters in their mouth could transmit the virus through contact with saliva droplets in environments such as the home and hospitals. There was evidence that transmission could occur through contaminated utensils or bedding. The new Clade I-b appeared to be more transmissible from person to person. The modes of transmission were still unclear and more research was required. The risk to the general population was low. There needed to be political commitment to eliminating the disease. Europe needed to stand in solidarity with the African region.

Mr Jašarević said there were two vaccines used for mpox. WHO had been discussing the availability of these vaccines with the manufacturers. It had triggered an emergency use listing process to accelerate the availability of those vaccines, which were already authorised for use in the Democratic Republic of the Congo.

The manufacturer of the MVA-BN vaccine, Bavarian Nordic, had the capacity to produce 10 million doses of the vaccine by the end of 2025 and could supply up to two million doses this year. Japan had a large stockpile of the LC16 vaccine, which was commissioned for production by the Japanese Government. The Japanese Government had been generous with its vaccine donations in the past and was currently negotiating with the Government of the Democratic Republic of the Congo regarding distribution of supplies of the vaccine. Both vaccines had been used previously. There was a third vaccine, ACAM2000, that was recommended for use when the other two were unavailable. This was a second-generation smallpox vaccination that was produced in the United States.

Further studies would provide additional information on the effectiveness of the vaccines in different settings. It took several weeks for vaccines to become effective. The vaccines had been developed to combat smallpox, which was of the same disease family as mpox. WHO was working with partners in the interim medical countermeasures network to enable donations of vaccines from existing stockpiles. It was recommending targeted rather than mass vaccination campaigns.

We needed to assess the groups at risk of contracting mpox and develop countermeasures. WHO did not recommend wearing masks to prevent transmission of the disease. The virus was transmitted through close skin-to-skin contact or contact with animals. There needed to be strong health systems that were aware of where viruses were. Countries needed to have surveillance systems in place and clinical testing capacity. The temporary recommendations released yesterday stressed preparedness. A pandemic treaty could help in strengthening global preparedness for an mpox outbreak.

There was a global dashboard that gave an overview of the number of lab-confirmed and reported mpox cases and the countries in which the cases were found, as well as a dashboard for the European region. Mpox was recently identified for the first time in Burundi, Kenya, Rwanda and Uganda. Many countries had the capacity to detect the disease.

Dr Catherine Smallwood, Emergency Operations Program Area Manager, Regional Office for Europe, World Health Organization (WHO) said there was only one case of clade I-b reported in Europe, in Sweden, which presented only clinically mild symptoms. Most of the 27,000 mpox cases reported in Europe since 2022 had clinically mild symptoms. However, some patients, especially those who had some immunodeficiency, could go on to have severe disease. There was data showing more severe disease associated with clade I-b, which was emerging in Africa. There were still knowledge gaps to be filled regarding clade I-b. We needed to work together to investigate each case. In Europe, WHO had committed to extensively investigating the clinical profiles of cases.

We needed to lower the bar of suspicion for mpox. In 2017, the disease changed epidemiology, and then changed again in 2022, when there were up to 2,000 cases per week in Europe among men who had sex with men. Clinicians were continuing to monitor this group but were also considering other population groups and not discounting patients because of their population group.

Clade I had been split into clades I-a and I-b to reflect the split in epidemiology. Clade I-a, which had circulated for a long time in the Democratic Republic of the Congo, was typically transmitted to humans through animals, while I-b was transmitted exclusively through the human population. More understanding was needed about the difference between I-b and other clades circulating around the world.

WHO was confident that the vaccines developed for smallpox would be effective against mpox. Whether or not persons went on to develop the disease depended on past vaccine exposure. Persons at high risk were encouraged to get vaccinated. WHO would publish in the coming days a summary of the effectiveness of the vaccination programme held in Europe in 2022.

Humanitarian Aid Efforts in Sudan

In response to questions, Olga Sarrado for United Nations High Commissioner for Refugees (UNHCR) said that UNHCR planned to transport around 1,200 core relief items and emergency kits to Sudan today. Two trucks planned to move from Chad to the Adri crossing today as part of the inter-agency convoy and two remaining tracks would be scheduled for tomorrow.

Announcements

Javier Gutiérrez, Counsellor, World Trade Organization (WTO), said WTO was organising its Public Forum, which would be held from 10 to 13 September in Geneva. He said that this was the biggest outreach event of the WTO. In 2023, WTO broke its record for participants in the Forum, and a week before registration was due to close for this year, it had already surpassed last year’s record. This signalled that there was an enduring strong interest in the WTO.

Over the four days of the Forum, there would be over 120 independently organised discussions centred around the topic of re-globalisation and how to make trade more inclusive.

On 10 September, the Peterson Institute for International Economics (PIIE) would organise a plenary debate on trade and geopolitics.

On 11 September, the official opening of the forum would take place with a lecture by Jason Furman from Harvard University. Jason was formerly the chair of the council of economic advisors of United States President Barack Obama. This would be followed by plenaries on the WTO’s 30^th anniversary and on how to reinvigorate agricultural negotiations in the WTO.

On 12 September, there would be two plenaries, one examining whether market access or domestic policies had the bigger influence in preventing countries from trading, and one on how to better use the special and differential treatment provisions in the WTO. Later that day, there would be a head of agency panel discussing the economic case for inclusivity.

On 13 September, there would be a plenary on how young people think globalisation can be improved.

These panels provided WTO members with food for thought or a different perspective on long standing issues, which could help them during negotiations. There would be over 600 speakers in the four days, including ministers, Chief Executive Officers and thought leaders. Some sessions could be followed online. Members of the public wishing to attend the Forum could contact the WTO’s media team for more information. Journalists with United Nations badges could access WTO premises during the event.

Fernando Puchol for the World Trade Organization (WTO) said that the day before the start of the Public Forum, WTO Chief Economist Ralph Ossa would hold an embargoed press conference on World Trade Report, which would be launched the following day

Michele Zaccheo, Chief, UNTV, Radio and Webcast Section, United Nations Information Service (UNIS) in Geneva, thanked all those who participated in events held yesterday to commemorate World Humanitarian Day. He said that 21 August was International Day of Remembrance and Tribute to the Victims of Terrorism and 22 August was the International Day Commemorating the Victims of Acts of Violence Based on Religion or Belief.

The Committee on the Elimination of Racial Discrimination (113th session, 5-23 August) would conclude its session next Friday, 23 August, and issue its concluding observations on the reports of the seven countries reviewed during this session: Venezuela, Iran, Pakistan, Bosnia-Herzegovina, United Kingdom, Iraq and Belarus. At 9:15 a.m. on Friday, the Committee would present its findings on these States in a press conference. Speaking would be Michal Balcerzak, Chair of the Committee, Régine Esseneme, Vice Chair of the Committee, and Committee Experts Gün Kut and Bakari Sidiki Diaby.

The Committee on the Rights of Persons with Disabilities (31st session, 12 August-5 September) was concluding this morning its review of the report of Ghana and would begin this afternoon the review of the report of Belarus.

The Conference on Disarmament (third and last part of its 2024 session, 29 July to 13 September) was holding this morning (10 am, Tempus) a public plenary meeting, the first under the presidency of Daniel Meron of Israel.

ANNOUNCEMENTS

- WTO Fernando Puchol with Javier Gutiérrez, WTO Counsellor: WTO Public Forum

TOPICS

- WHO Tarik Jašarević with Dr Hans Kluge, WHO regional Director for Europe (From France): Preparedness in European region regarding MPOX