General Science & Health

Around 560 000 children under ten years old were vaccinated against polio during the first round of an emergency vaccination campaign conducted in three phases from 1-12 September 2024 in the Gaza Strip.

The 12-day campaign provided novel oral polio vaccine type 2 (nOPV2) to 558 963 children, following meticulous planning and coordination. This involved the use of an extensive network of teams, vaccinating at selected fixed sites at health facilities and outreach posts. Mobile and transit teams actively reached out to families living in shelter homes, tents, and camps for the displaced, alongside community workers engaging families to raise awareness ahead of and during the campaign. For each phase, an area-specific humanitarian pause of nine hours daily was agreed to ensure the safety of communities and health workers, and enable vaccination efforts.

“Health and community workers have shown incredible resilience, carrying out this campaign at unprecedented scale and speed under the toughest conditions in Gaza. Swift action by the Global Polio Eradication Initiative—from the moment the virus was detected to the launch of the vaccination campaign—speaks to the effectiveness of the polio programme. In areas where humanitarian pauses took place, the campaign brought not just vaccines, but moments of calm. As we prepare for the next round in four weeks, we’re hopeful these pauses will hold, because this campaign has clearly shown the world what’s possible when peace is given a chance,” said Dr Richard Peeperkorn, WHO Representative for the occupied Palestinian territory (oPt).

“It was critical this ambitious campaign was carried out quickly, safely and effectively to protect children in the Gaza Strip and neighbouring countries from the life-altering poliovirus,” said Jean Gough, UNICEF Special Representative in the State of Palestine. “The progress made in this first round is encouraging, but the job is far from done. We are poised to finish the task and call on all involved to ensure we can do so in the next round in four weeks' time, for the sake of children everywhere.”

Partners at all levels recognize common operational challenges faced during these efforts, including devastated infrastructure, from health facilities to roads, limited trained healthcare workers, access issues due to insecurity, limited fuel for generators used to safely store vaccines and freeze ice packs, and constant population movements. However, these issues were addressed in a timely manner, with the key support of the Palestinian Ministry of Health and UNRWA, to enable planned vaccination activities.

Despite these challenges and the conditions that families in the Gaza Strip have endured over the past 11 months, families flocked to health facilities to get their children vaccinated. This can be attributed to traditionally positive health seeking behaviour among the Palestinian people and an impactful campaign to raise awareness and mobilize the public.

The original target for the campaign was 640 000 children, estimated in the absence of an accurate survey, which may have been an over-estimate, as the population continues to move from place to place, and people are fleeing and being killed due to the ongoing hostilities. During the campaign, trained monitoring teams were deployed to oversee vaccination efforts. As next steps, an additional 65 independent monitors are being deployed to cross-check the proportion of children vaccinated across the Gaza Strip to independently assess the level of coverage achieved in the first round. They need safe, unimpeded access so they can visit households, markets, transit points, and health facilities to check children for the prominent purple dye marked on their little finger when they are vaccinated. These efforts will provide an independent measure of the percentage of vaccination coverage achieved and reasons for any unvaccinated children.

A second round of the campaign will follow, ideally within four weeks, to provide a second dose of nOPV2 to children in Gaza to stop the outbreak and prevent its international spread.

To repeat this ambitious intervention, reach enough children, and successfully stop further transmission of the poliovirus, WHO, UNICEF and UNRWA are calling on all parties to the conflict to commit to  another round of humanitarian pauses, with unimpeded access to children in areas that need special coordination.

Ultimately, we need a long-lasting ceasefire as all families in the Gaza Strip need peace so they can begin to heal and rebuild their lives.

Notes to editors:

The campaign was implemented as part of an urgent and robust response to the confirmation of circulating variant poliovirus type 2 (cVDPV2) in Gaza, which was found in the environment in July 2024, and in a 10-month-old child in August 2024. It was conducted by the Palestinian Ministry of Health (MOH), in collaboration with the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and partners. The Global Polio Eradication Initiative (GPEI) members, donors, WHO Member States and partners in oPt, including as part of the Health Cluster, played a key role in facilitating the campaign. 

The campaign kicked off using 473 teams, including 230 mobile teams, and 143 vaccination sites, in central Gaza, followed by 91 fixed sites, complemented by 384 mobile teams in southern Gaza. It concluded in northern Gaza, reaching children through 127 teams at fixed sites and 104 mobile teams. Fixed sites comprised hospitals, medical points, primary health centres, temporary learning spaces, schools, and food and water distribution points. Additionally, 749 social mobilizers were trained and deployed to engage communities, before and during the campaign to nudge families to vaccinate their children and address concerns.

Novel oral polio vaccine (nOPV2) is a polio vaccine being used to stop transmission of variant poliovirus type 2 (cVDPV2), currently the most prevalent form of the variant poliovirus. nOPV2 is safe and effective and offers protection against paralysis and community transmission. It is the vaccine globally recommended for variant type 2 poliovirus outbreaks – the type that has been found in Gaza.

WHO has updated its guidelines for the care of patients with influenza. The guidelines are designed primarily for health care providers who manage patients with influenza virus infection, and will also serve as a reference source for policymakers and others in efforts towards epidemic and pandemic preparedness.

Influenza is a viral disease. Seasonal influenza is common in all parts of the world. It is estimated that there are around a billion cases of seasonal influenza annually, including 3–5 million cases of severe respiratory illness. An estimated 290 000-650 000 deaths each year are due to seasonal influenza related respiratory disease, in addition to the deaths related to other influenza-related complications.

Along with seasonal influenza viruses, animal influenza viruses – most commonly avian and swine influenza viruses – can occasionally infect humans. They can cause disease ranging from mild conjunctivitis to severe pneumonia and even death. Current animal influenza viruses have not shown the capacity to transmit from person to person, but do pose a pandemic threat for the future.

These guidelines provide recommendations on the use of antiviral medications, and other treatments such as steroids for immune system regulation. This update applies to patients with seasonal influenza viruses, potential pandemic influenza viruses, and new influenza type A viruses that are known to cause severe illness in infected humans. 

A Guideline Development Group of content experts, clinicians, patients, ethicists and methodologists analysed available data and produced these recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

The recommendations form part of WHO’s response to influenza, which includes the work of the Global Influenza Surveillance and Response System (GISRS), and the Pandemic Influenza Preparedness (PIP) framework which addresses gaps in access to effective medical therapies and other tools.

In coordination with Member States, the World Health Organization (WHO) and partners have established an access and allocation mechanism for mpox medical countermeasures including vaccines, treatments and diagnostic tests. The Access and Allocation Mechanism (AAM) will increase access to these tools for people at highest risk and ensure that the limited supplies are used effectively and equitably.   

This is part of the response to the public health emergency of international concern declared by WHO Director-General Dr Tedros Adhanom Ghebreyesus on 14 August 2024, following an upsurge of mpox in the Democratic Republic of the Congo and neighbouring countries. Fifteen countries in Africa have reported mpox this year. Recommendations issued on the advice of the International Health Regulations Emergency Committee asked States Parties to ensure "equitable access to safe, effective and quality-assured countermeasures for mpox.”  

“Alongside other public health interventions, vaccines, therapeutics and diagnostics are powerful tools for bringing the mpox outbreaks in Africa under control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The COVID-19 pandemic illustrated the need for international coordination to promote equitable access to these tools so they can be used most effectively where they are most needed. We urge countries with supplies of vaccines and other products to come forward with donations, to prevent infections, stop transmission and save lives.” 

The AAM was established as a part of the interim Medical Countermeasures Network (i-MCM-Net). The i-MCM-Net brings together partners from around the world, including UN and other international agencies, health organizations, civil society organizations, industry and private sector to build an effective ecosystem for the development, manufacturing, allocation and delivery of medical countermeasures. The network was endorsed by WHO Member States as a mechanism to operate in the interim, as negotiations continue towards a pandemic agreement. 

Along with WHO, the AAM for mpox includes members of the i-MCM-Net: the Africa Centres for Disease Control and Prevention, the Coalition for Epidemic Preparedness Innovations, the EU’s Health Emergency Preparedness and Response Authority, FIND, Gavi, the PAHO Revolving Fund, UNICEF, Unitaid and others. 

Over 3.6 million doses of vaccines have been pledged for the mpox response.  This includes 620 000 doses of the MVA-BN vaccine pledged to affected countries by the European Commission, Austria, Belgium, Croatia, Cyprus, France, Germany, Luxembourg, Malta, Poland, Spain, and the United States of America, as well as vaccine manufacturer Bavarian Nordic. Japan has pledged 3 million doses of the LC16 vaccine, the largest number of doses pledged so far.   

The recent surge in mpox cases, coupled with the limited availability of vaccines and other medical countermeasures, underscores the need for a collaborative and transparent process to distribute these critical resources fairly. The AAM is working to allocate the currently scarce supplies of vaccines and diagnostics for those at the highest risk of infection, including for vaccinating contacts of confirmed cases, and providing access to point of care diagnostics to countries with ongoing mpox outbreaks so that people who might be suspected cases can systematically be tested and cared for.  

The AAM will operate based on these guiding principles:  

• Preventing illness and death: Prioritize vaccination and other tools to interrupt transmission for those at greatest risk to prevent illness and death.  
• Mitigating inequity: Ensure equitable access to medical countermeasures for all people at risk, irrespective of socio-economic or demographic background.  
• Ensuring transparency and flexibility: Establish and maintain clear and open communication about allocation decisions and be ready to adapt strategies as new data emerge or situations change. 

“WHO and partners are supporting the government of the Democratic Republic of the Congo and other countries to implement an integrated approach to case detection, contact tracing, targeted vaccination, clinical and home care, infection prevention and control, community engagement and mobilization, and specialized logistical support,” said Dr Mike Ryan, Executive Director of WHO’s Health Emergencies Programme. “The AAM will provide a reliable pipeline of vaccines and other tools in order to ensure the success on the ground in interrupting transmission and reducing suffering.”  

The World Health Organization (WHO) has announced the MVA-BN vaccine as the first vaccine against mpox to be added to its prequalification list.

The prequalification approval is expected to facilitate timely and increased access to this vital product in communities with urgent need, to reduce transmission and help contain the outbreak. WHO’s assessment for prequalification is based on information submitted by the manufacturer, Bavarian Nordic A/S, and review by the European Medicines Agency, the regulatory agency of record for this vaccine.

“This first prequalification of a vaccine against mpox is an important step in our fight against the disease, both in the context of the current outbreaks in Africa, and in future,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We now need urgent scale up in procurement, donations and rollout to ensure equitable access to vaccines where they are needed most, alongside other public health tools, to prevent infections, stop transmission and save lives.”

The MVA-BN vaccine can be administered in people over 18-years of age as a 2-dose injection given 4 weeks apart. After prior cold storage, the vaccine can be kept at 2–8°C for up to 8 weeks.

“The WHO prequalification of the MVA-BN vaccine will help accelerate ongoing procurement of the mpox vaccines by governments and international agencies such as Gavi and Unicef to help communities on the frontlines of the ongoing emergency in Africa and beyond,” said Dr Yukiko Nakatani, WHO Assistant Director-General for Access to Medicines and Health Products. “The decision can also help national regulatory authorities to fast-track approvals, ultimately increasing access to quality-assured mpox vaccine products.”

The WHO Strategic Advisory Group of Experts (SAGE) on Immunization reviewed all available evidence and recommended the use of MVA-BN vaccine in the context of an mpox outbreak for persons at high risk of exposure. While MVA-BN is currently not licensed for persons under 18 years of age, this vaccine may be used “off-label” in infants, children and adolescents, and in pregnant and immunocompromised people. This means vaccine use is recommended in outbreak settings where the benefits of vaccination outweigh the potential risks.

WHO also recommends single-dose use in supply-constrained outbreak situations. WHO emphasizes the need to collect further data on vaccine safety and effectiveness in these circumstances.

Available data shows that a single-dose MVA-BN vaccine given before exposure has an estimated 76% effectiveness in protecting people against mpox, with the 2-dose schedule achieving an estimated 82% effectiveness. Vaccination after exposure is less effective than pre-exposure vaccination.

Good safety profile and vaccine performance has been consistently demonstrated in clinical studies, as well as in real-world use during the ongoing global outbreak since 2022. In light of the changing epidemiology and emergence of new virus strains, it remains important to collect as much data as possible on vaccine safety and effectiveness in different contexts.

Since the triggering of the emergency use listing for mpox vaccines by WHO Director-General on 7 August 2024, WHO has conducted product and programmatic suitability assessments of MVA-BN vaccine.

“The findings of the assessments are particularly relevant in the context of the declaration of a public health emergency of international concern (PHEIC) related to the upsurge of mpox in Africa,” said Dr Rogerio Gaspar, WHO Director for Regulation and Prequalification. “We are progressing with prequalification and emergency use listing procedures with manufacturers of two other mpox vaccines: LC-16 and ACAM2000. We have also received 6 expressions of interest for mpox diagnostic products for emergency use listing so far.”

The escalating mpox outbreak in the Democratic Republic of the Congo and other countries was declared a PHEIC by the WHO Director-General on 14 August 2024. 

Over 120 countries have confirmed more than 103 000 cases of mpox since the onset of the global outbreak in 2022. In 2024 alone, there were 25 237 suspected and confirmed cases and 723 deaths from different outbreaks in 14 countries of the African Region (based on data from 8 September 2024).

Editor’s note:

WHO Prequalification (PQ) and Emergency Use Listing (EUL) are mechanisms used to evaluate quality, safety and efficacy of medical products, such as vaccines, diagnostics and medicines (optional: including biotherapeutics), and product suitability for use in an low- and middle-income country context. PQ or EUL listed products assist decision for international, regional and country procurement by UN and partner procurement agencies and member states. PQ is based on the review of full set of quality, safety and efficacy data on medical products, including risk management plan and programmatic suitability. EUL is a risk benefit assessment to address urgent demands during public health emergencies based on available limited data. Under EUL, the manufacturers are required to commit to continue generating missing information to fulfil prequalification requirements. Once this information becomes available, a PQ application should be submitted to complete the full process to achieve recommendation for international procurement in both emergency and non-emergency settings. 

At least one quarter or 22 500 of those injured in Gaza by 23 July are estimated to have life-changing injuries that require rehabilitation services  now and for years to come, according to a  World Health Organization (WHO) analysis of the types of injuries resulting from the ongoing conflict in Gaza: Estimating Trauma Rehabilitation Needs in Gaza using Injury Data from Emergency Medical Teams.  

The analysis found that severe limb injuries, estimated to be between 13 455 to 17 550, are the main driver of the need for rehabilitation. Many of those injured have more than one injury. According to the report, between 3105 and 4050 limb amputations have also occurred. Large surges in spinal cord injury, traumatic brain injury and major burn injuries all contribute to the overall number of life-changing injuries, which includes many thousands of women and children.

“The huge surge in rehabilitation needs occurs in parallel with the ongoing decimation of the health system,” said Dr Richard Peeperkorn, WHO Representative in the occupied Palestinian territory. “Patients can’t get the care they need. Acute rehabilitation services are severely disrupted and specialized care for complex injuries is not available, placing patients' lives at risk. Immediate and long-term support is urgently needed to address the enormous rehabilitation needs.” 

Currently, only 17 of 36 hospitals remain partially functional in Gaza, while primary health care and community-level services are frequently suspended or rendered inaccessible due to insecurity, attacks, and repeated evacuation orders. Gaza’s only limb reconstruction and rehabilitation center, located in Nasser Medical Complex and supported by WHO, became non-functional in December 2023 due to lack of supplies and specialized health workers being forced to leave in search of safety, and was later left damaged following a raid in February 2024. Tragically, much of the rehabilitation workforce in Gaza is now displaced. Reports indicate 39 physiotherapists have been killed as of 10 May. In-patient rehabilitation and prosthetic services are no longer available and the number of people with injuries requiring assistive products far exceeds the equipment available within Gaza. Partners report that stocks of essential assistive products such as wheelchairs and crutches have run out and it is difficult to replenish supplies due to the restricted flow of aid into Gaza.   

The analysis focuses solely on new injuries sustained since the escalation of hostilities in October 2023. However, tens of thousands of Palestinians in Gaza were already living with pre-existing chronic conditions and impairments before this, putting them at significant risk due to the lack of appropriate services. 

The estimates in the analysis will be used by WHO and partners to plan for a surge in rehabilitation-related services and contribute to long-term health planning and policymaking. 

Amidst the ongoing hostilities, it is critical to ensure access to all essential health services, including rehabilitation to prevent illness and death. WHO reiterates its call for a ceasefire, which is critical for rebuilding the health system to cope with escalating needs. 

Over 187 000 children under ten years of age were vaccinated with novel oral polio vaccine type 2 (nOPV2) in central Gaza during the first phase of a two-round polio vaccination campaign, conducted between 1–3 September 2024. Vaccination coverage in this phase exceeded the initial estimated target of 157 000 children due to population movement towards central Gaza, and expanded coverage in areas outside the humanitarian pause zone.  

To ensure no child is missed in this area, polio vaccination will continue at four large health facilities in central Gaza over the next few days. Vaccine doses have been supplied to these sites to meet any additional needs. 

“It has been extremely encouraging to see thousands of children being able to access polio vaccines, with the support of their resilient families and courageous health workers, despite the deplorable conditions they have braved over the last 11 months. All parties respected the humanitarian pause and we hope to see this positive momentum continue,” said Dr Richard Peeperkorn, WHO Representative for the occupied Palestinian territory.

The first phase of the campaign was conducted by 513 teams, consisting of over 2180 health and community outreach workers. Vaccination was provided at 143 fixed sites, including hospitals, medical points, primary care centres, camps where displaced people are living, key public gathering spaces such as temporary learning spaces, food and water distribution points, and transit routes leading from central towards northern and southern Gaza. Additionally, mobile teams visited tents and hard to-reach areas to ensure they reached families who were unable to visit fixed sites. The presence of a substantial number of children eligible for vaccination who were unable to reach vaccination sites due to insecurity, necessitated special missions to Al-Maghazi, Al-Bureij and Al-Mussader – areas just outside of the agreed zone for the humanitarian pause.  

Preparations are underway to roll out the next phase of the campaign, which will be conducted in southern Gaza from 5–8 September 2024, targeting an estimated 340 000 children below ten years of age. Some 517 teams, including 384 mobile teams, will be deployed. Nearly 300 community outreach workers have already begun outreach to families in southern Gaza to raise awareness about the campaign, while 490 vaccine carriers, 90 cold storage boxes, and other supplies have been transferred to Khan Younis for distribution to vaccination sites. 

The third and last phase of the polio vaccination campaign will be implemented in northern Gaza from 9–11 September 2024, targeting around 150 000 children.  

At least 90% vaccination coverage during each round of the campaign is needed to stop the outbreak, prevent the international spread of polio and reduce the risk of its re-emergence, given the severely disrupted health, water and sanitation systems in the Gaza Strip. Vaccination coverage will be monitored throughout the campaign, and, when necessary, vaccinations will be extended to meet coverage targets as part of flexible strategies to ensure every eligible child receives their vaccine dose. 

The two-round campaign, being conducted by the Palestinian Ministry of Health (MOH), in collaboration with the World Health Organization (WHO) and United Nations Children Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and many partners, aims to provide two drops of nOPV2 to around 640 000 children during each round. 

"The successful delivery of the first phase of the campaign in central Gaza is a culmination of immense coordination among various partners, including the Global Polio Eradication Initiative (GPEI) and donors, and underscores the importance of peace for the health and well-being of people in Gaza. We call on all parties to continue fulfilling their commitment to the humanitarian pauses as the second phase of the campaign begins tomorrow,” said Dr Peeperkorn. 

Notes to editors 

• The campaign is part of an urgent response to prevent the spread of polio after circulating variant poliovirus type 2 (cVDPV2) was detected in Gaza, after 25 years of being polio-free. cVDPV2 has been detected in six environmental samples – or wastewater – collected from central Gaza in June 2024. Gaza has reported four cases of children with acute flaccid paralysis (AFP), including one case of confirmed polio in a child who tested positive for circulating variant poliovirus type 2 (cVDPV2). Two of the reported cases tested negative for poliovirus. Laboratory results are pending on samples from the fourth AFP case.  

• Novel oral polio vaccine (nOPV2) is a polio vaccine being used to stop transmission of variant poliovirus type 2 (cVDPV2), currently the most prevalent form of the variant poliovirus. 

• nOPV2 is safe and effective and offers protection against paralysis and community transmission. It is the vaccine globally recommended for variant type 2 poliovirus outbreaks – the type that has been found in the recent samples from Gaza. 

With the support of the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO), the World Health Organization (WHO) has published a global framework to help Member States comprehensively investigate the origins of new and re-emerging pathogens. While there are a number of tools available for investigating infectious disease outbreaks, this is the first unified, structured approach to investigating the origins of a novel pathogen. This framework aims to fill that gap by providing a comprehensive set of scientific investigations and studies. It is the first version of a “how-to” guide that will be updated as and when needed, based on feedback from users.

As each outbreak and pandemic demonstrates, human and animal health is threatened by the increasing risk of the emergence of known (such as Ebola, Nipah, avian influenza, Lassa and Monkeypox viruses) and novel pathogens with epidemic and pandemic potential (novel influenza, MERS-CoV, SARS-CoV-1, SARS-CoV-2), the ability to prevent, and when we cannot prevent, to swiftly contain outbreaks and identify their origins is scientifically, morally, and financially more critical than ever.

The WHO global framework outlines scientific investigations and studies for six technical elements:

• Early investigations of the first identified cases/ clusters / outbreaks to identify potential sources of exposure, collection of samples at the source, define the characteristics of the novel pathogen involved for establishment of diagnostic assays.
• Human studies: to understand the epidemiology including clinical presentation, modes of transmission, pathology and earliest presence in syndromic surveillance samples. 
• Human/Animal interface studies to identify potential animal reservoirs, intermediate hosts and reverse zoonoses.
• studies to identify insect vectors or other sources of infection as well as earliest presence in the environment.  …
• Genomics and Phylogenetics studies to identify precursor strains, genomic characteristics, evolution in intermediate hosts and humans and spatial distribution over time.
• Biosafety/Biosecurity studies to determine if a breach in laboratory or research activities may have been associated with the first cases.

The WHO Global framework has been designed as a resource for scientists, researchers, public health authorities, and investigators in Member States. It provides guidance when and how to initiate such multi-disciplinary investigations and offers recommendations to countries on the capacities and tools needed to successfully implement them.  This includes the capacities needed such as human resources, human, animal, and environmental surveillance systems; biosafety and biosecurity regulations; and laboratories with testing and sequencing expertise – and the importance of sharing the findings of such investigations as soon as possible to guide next steps. These recommendations were developed to align with the International Health Regulations (IHR) and using a One Health approach.

Timely and comprehensive investigations into pathogens’ origins are critical for preventing and containing global health crises. The findings from such investigations provide the basis for stopping outbreaks before they begin, halting transmission chains and reducing the risk of pathogen spillover from animals to humans.  They also can confirm or exclude the possibility of an unintentional breach in laboratory biosafety and biosecurity.

To achieve this, is it critical for countries to conduct these are sharing initial findings in a rapid, complete and transparent manner as soon as results are available to ensure the implementation of measures to mitigate further transmission and prevent new spillover events and, eventually, future pandemics.

“Understanding when, where, how and why epidemics and pandemics begin is both a scientific imperative, to prevent future outbreaks, and a moral imperative for the sake of those who lose their lives to them,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This framework provides for the first time comprehensive guidance on the studies that are needed to investigate the origins of emerging and reemerging pathogens. If it had been in place when COVID-19 struck, the quest to understand its origins may have been less contentious and more successful. WHO continues to call on China to share all information it has on the origins of COVID-19, so that all hypotheses can be investigated.”

Established in November 2021 and made up of independent experts from around the world, the SAGO was tasked with identifying the best technical and scientific approaches to understanding the origins of emerging and re-emerging pathogens and developing this global framework. The SAGO forms part of a strengthened health emergency preparedness and prevention system developed by WHO, its Member States and many health and scientific partners.

The World Health Organization (WHO) has published global cholera statistics for 2023, showing an increase in cases and deaths.  

The number of reported cholera cases increased by 13% and deaths by 71% in 2023 compared to 2022. Over 4000 people died last year from a disease that is preventable and easily treatable. 

Forty-five countries reported cases, an increase from 44 the previous year and 35 in 2021. Thirty-eight per cent of the reported cases were among children under five years of age.  

Cholera is an acute intestinal infection spread through contaminated food and water. Communities with limited access to sanitation are most affected. 

Conflict, climate change, inadequate safe water and sanitation, poverty, underdevelopment, and population displacement due to emerging and re-emerging conflicts and disasters from natural hazards all contributed to the rise in cholera outbreaks last year. 

The geographical distribution of cholera changed significantly from 2022 to 2023, with a 32% decrease in cases reported from the Middle East and Asia, and a 125% increase in Africa. Many countries in Africa reported a high proportion of community deaths, indicating gaps in access to treatment. 

This is the first year that multiple countries have reported deaths from cholera which occurred outside of health facilities, known as ‘community deaths’. In five out of 13 reporting countries, over a third of cholera deaths occurred in the community, highlighting serious gaps in access to treatment and the need to strengthen this area of response. 

Afghanistan, the Democratic Republic of the Congo, Malawi and Somalia continued to report large outbreaks of over 10 000 suspected or confirmed cases, with Ethiopia, Haiti, Mozambique and Zimbabwe adding to the tally in 2023. 

Preliminary data show that the global cholera crisis continues into 2024, with 22 countries currently reporting active outbreaks. Although the number of cases reported so far in 2024 is lower compared to the same period last year, 342 800 cases and 2400 deaths have already been reported to WHO across all continents as of 22 August.  

The increased demand for cholera materials such as oral cholera vaccines (OCV), diagnostic tests and essential medications like oral rehydration salts and intravenous fluids for rehydration persists into 2023, posing a challenge for disease control efforts globally. Since October 2022, the International Coordinating Group (ICG), which manages emergency vaccine supplies, has suspended the standard two-dose vaccination regimen in cholera outbreak response campaigns, adopting a single-dose approach instead in order to reach and protect more people given limited supplies. 

Despite the low stockpile of OCV, a record 35 million doses were shipped last year, with the one-dose strategy in effect. While vaccination is an important tool, safe drinking water, sanitation and hygiene remain the only long-term and sustainable solutions to ending cholera outbreaks and preventing future ones.  

WHO considers the current global risk from cholera as very high and is responding with urgency to reduce deaths and contain outbreaks in countries around the world. WHO continues to support countries through strengthened public health surveillance, case management, and prevention measures; provision of essential medical supplies; coordination of field deployments with partners; and support for risk communication and community engagement. 

The World Health Organization (WHO) and the Republic of Korea have a long-standing partnership spanning over 75 years. As a result of their fruitful collaboration, there has been significant progress in health and development all around the world. The Republic of Korea has gone from being a donor-recipient country to a donor-country and is now a leader in global health and playing a critical role on the world stage.

^{Dr Catharina Boehme, Assistant Director-General for External Relations and Governance (WHO) and Dr Hye-Jin Kim, Deputy Minister for Planning and Coordination (Ministry of Health and Welfare, Republic of Korea), together with counterparts from WHO and the Government of the Republic of Korea. © WHO}

To further strengthen this partnership and our commitment to working jointly to address global health challenges, WHO and the Republic of Korea convened their second Strategic Dialogue in Seoul from 28 to 29 August 2024. Dr Catharina Boehme, Assistant Directory-General for External Relations and Governance, led the WHO delegation and was accompanied by an in-person team and colleagues participating virtually from the three levels of the Organization (headquarters, regional, and country offices).

Dr Hye-Jin Kim, Deputy Minister for Planning and Coordination, Ministry of Health, led the Republic of Korea delegation and was joined by senior officials including Dr Young-Mee Jee, Commissioner, Korea Disease Control and Prevention Agency, as well as senior counterparts from the Ministry of Foreign Affairs, and the Ministry of Food and Drug Safety.

In addition, in line with WHO's work to enhance collaboration with parliamentarians, the WHO delegation also met with various Members of the National Assembly that are championing the global health agenda.

The recently concluded two-day meeting resulted in an alignment of priorities and paved the way for enhanced collaboration between WHO and the Government of Korea.

^{WHO delegation with Mr Jonghan Park, Director-General, Development Cooperation (Ministry of Foreign Affairs) - holding up the WHO Investment Case report. © WHO}

UNICEF today announced that it has issued an emergency tender for the procurement of mpox vaccines. Vaccines can play a critical role in containing the mpox outbreak which was declared a public health emergency by both the Africa Centres for Disease Control and Prevention (Africa CDC) and the World Health Organization (WHO).

The UNICEF tender is issued to help secure mpox vaccines for the hardest hit countries in collaboration with Africa CDC, Gavi, the Vaccine Alliance, WHO, the Pan American Health Organization and other partners. This collaboration to increase access and timely allocation also includes working together to facilitate donations of vaccines from existing stockpiles in high-income countries with the aim of containing the ongoing transmission of mpox.

Under the emergency tender, UNICEF will set up conditional supply agreements with vaccine manufacturers. This will enable UNICEF to purchase and ship vaccines without delay once countries and partners have secured financing, confirmed demand and readiness, and the regulatory requirements for accepting the vaccines are in place. WHO is currently reviewing the information submitted by manufacturers on 23 August and is expected to complete its review for Emergency Use Listing by mid-September.

More than 18 000 suspected cases of mpox, including 629 deaths, have been reported this year in the Democratic Republic of the Congo which is at the epicentre of the crisis. Four out of five deaths have been in children.

“Addressing the current mpox vaccine shortage and delivering vaccines to communities who need them now is of paramount importance. There is also a pressing need for a universal and transparent allocation mechanism to ensure equitable access to mpox vaccines,” said Director of UNICEF Supply Division Leila Pakkala.

“As we confront the ongoing mpox outbreak, the timely procurement and distribution of vaccines is crucial to protecting the most vulnerable populations, particularly in the hardest-hit regions. This emergency tender is a critical step forward in our collective effort to control the spread of this disease. Africa CDC is committed to ensuring that vaccines are allocated swiftly and equitably across the continent, in partnership with UNICEF, Gavi, WHO, and other key stakeholders. Our unified response is essential to curbing the impact of this public health emergency and safeguarding the health and well-being of our communities,” said Dr. Jean Kaseya, Director General of Africa CDC.

“With several partners working on securing access to supply, today’s announcement represents an important step in this emergency, enabling UNICEF to purchase and deliver vaccines after Gavi and other partners make funding available and sign purchase or donation agreements with manufacturers for the most immediate dose needs,” said Dr Derrick Sim, interim Chief Vaccine Programmes and Markets Officer at Gavi, the Vaccine Alliance. “Securing access to supply and financing, delivering doses, and in parallel ensuring countries are ready to administer them, are all vital actions that need to be conducted rapidly but thoroughly, and in a coordinated manner. We welcome this tender as another positive step our Alliance and Africa CDC are taking in this response.”

“A swift, coordinated, and equitable response is critical to controlling the current mpox emergency and preventing future ones,” said Dr Maria Van Kerkhove, WHO incident manager for the global mpox response and acting Director for Epidemic and Pandemic Preparedness and Prevention. “All of us must act decisively now or risk allowing mpox to spread further and become an even greater global threat. In an interconnected world, the fight against mpox – as with other infectious diseases and health threats – cannot be waged alone., WHO is glad to partner with UNICEF, Gavi, Africa CDC, other partners and affected countries to get life-saving tools to people in need.”

The emergency tender is designed to secure immediate access to available mpox vaccines as well as to expand production. Depending on demand, production capacity of manufacturers and funding, agreements for up to 12 million doses through 2025 can be put in place.

Vaccines are one of several tools used to interrupt transmission and to protect children and communities against mpox. Africa CDC, Gavi, UNICEF, WHO, and partners are also prioritizing infection prevention and control, and risk communication and community engagement. As part of this, UNICEF is deploying personal protection equipment, diagnostic tests, medical treatment kits, hygiene supplies and tents to countries at the forefront of the crisis. These supplies support a host of medical countermeasures such as treatment, case isolation and surveillance.

UNICEF is the world’s largest single vaccine buyer, procuring more than 2 billion doses of vaccines annually for routine child immunization and outbreak response on behalf of nearly 100 countries.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.

About Africa CDC

The Africa Centres for Disease Control and Prevention (Africa CDC) is a continental autonomous public health agency of the African Union that supports member states in efforts to strengthen health systems and improve surveillance, emergency response, and prevention and control of diseases.

About Gavi, the Vaccine Alliance

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners. 

Since its inception in 2000, Gavi has helped to immunise a whole generation – over 1 billion children – and prevented more than 17.3 million future deaths, helping to halve child mortality in 78 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency.

About WHO

Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable.

WHO has asked manufacturers of mpox in vitro diagnostics (IVDs) to submit an expression of interest for Emergency Use Listing (EUL). WHO has been in ongoing discussions with manufacturers about the need for effective diagnostics, particularly in low-income settings. The request for EUL expressions of interest by manufacturers is the latest development in these discussions.

Testing is key for people to get treatment and care as early as possible and prevent further spread. Since 2022, WHO has delivered around 150 000 diagnostic tests for mpox globally, of which over a quarter have gone to countries in the African Region. In the coming weeks, WHO will deliver another 30 000 tests to African countries.

With as many as 1000 suspected cases reported in the Democratic Republic of the Congo alone this week, the demand for diagnostic tests is on the rise. In this heavily affected country, WHO has worked with partners to scale up diagnostic capacity to respond to the upsurge of cases. Since May 2024, six additional labs have been equipped to diagnose mpox, enabling a decentralization of testing capacity from major cities to affected provinces. Two of these labs are in South Kivu, selected to respond to the outbreak of the new viral strain, called Ib. Thanks to these efforts, testing rates have dramatically improved in the country, with four times as many samples tested in 2024 so far as compared to 2023.

WHO has also updated its diagnostic testing guidance to detect the new virus strain and is working with countries to roll it out. Earlier, WHO issued target product profiles to guide manufacturers in the development of new diagnostic tests.

WHO Director-General Dr Tedros Adhanom Ghebreyesus declared on 14 August 2024 that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and in a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005).

Manufacturers of IVDs are now asked to submit available quality, safety and performance data to WHO as soon as they can. IVDs are tests done in laboratories to detect a pathogen. Detection of viral DNA by PCR (Polymerase Chain Reaction) testing is the gold standard for mpox diagnosis. It detects the virus's DNA in samples taken from skin lesions, such as fluid or crusts from vesicles or pustules. Testing of blood is not recommended for routine diagnosis and antibody detection methods may be used for retrospective case classification but not for diagnosis.

Through the EUL procedure, WHO can approve medical products such as vaccines, tests and treatments for use, evaluating the acceptability of using specific products for time-limited procurement in emergency situations. The process aims to assist countries, which have not approved the medical products through national approval processes, to procure the critically needed products such as tests through UN agencies and other partners.

Mpox is an illness caused by the monkeypox virus, a species of the genus Orthopoxvirus, that can be transmitted to humans through contacts with someone who is infectious, with contaminated materials, or with infected animals.

Expanding access to diagnostic services is urgently needed as tests are essential to critical measures such as strengthened laboratory capacity, improved case investigation, contact tracing, surveillance data collection, and timely reporting. As a package, these help countries identify chains of transmission, detect cases early, prevent further spread, and monitor the virus in real-time. The establishment of Emergency Use Listing procedures for mpox diagnostic tests will help advance towards this goal.

The World Health Organization (WHO) and International Paralympic Committee (IPC) are joining forces to highlight the transformative impact of assistive technology on sports during the Paris 2024 Paralympic Games. The "Equipped for equity" campaign emphasizes the crucial role of assistive technology for Paralympic athletes to advocate for concerted global action to improve access to these essential health products.

Throughout the Games, WHO and IPC will leverage the Paralympics platform to share messages and information focused on the importance of assistive technology, how athletes use it, and why universal access is essential. Examples of assistive technology used by Paralympians include: running blades, wheelchairs, and release braces in archery.

The “Equipped for equity” campaign will also feature personal stories from athletes who rely on assistive technology for sport and in daily life and highlight national successes in advancing access to these critical health products.

“The Paralympics show us what is possible, and the important role that assistive technology plays for these extraordinary athletes,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But around the world, many people still do not have access to crucial assistive technology, due to its high cost and low availability. We call on governments, donors, and civil society to prioritise these neglected but critical products, by integrating them in primary care programmes as part of their journey towards universal health coverage.”

Andrew Parsons, President, IPC noted, “The Paralympic Games are one of the only global events that put persons with disabilities front and centre, and in many events highlight how assistive technology can support athletes to compete at the highest level. These technologies allow them to redefine what is possible in sports and inspire millions around the world.”

“While we get ready to celebrate incredible athletic success, it is critical to remember that access to assistive technology remains a significant concern. We must advocate for more affordable and accessible solutions globally, ensuring that everyone, regardless of where they live, has the opportunity to lead a full life and contribute to society.”

WHO estimates that access to assistive technology remains severely limited in many parts of the world, with more than 2.5 billion people in need of assistive technology across the world. For instance, only 5-35% of the 80 million people who need a wheelchair have access to one, depending on where they live, and only 10% of the global demand for hearing aids is currently met. Without access to assistive technology, persons with disabilities are denied the right to participate in all aspects of life, and are also more at risk of exclusion, isolation and poverty.

The "Equipped for equity" campaign will showcase examples like Zimbabwe’s recent tax exemption on assistive technology and the pre-Paralympic tax reductions on assistive technology for sports in France and Japan. By highlighting these initiatives, the campaign calls on countries to implement similar initiatives and integrate assistive technology into primary health care and universal health coverage.

Measures to make assistive technology more accessible and affordable are essential not only for empowering individuals to participate fully in life but also for driving broader societal and economic development. Expanding access to quality-assured, safe, and affordable assistive technology reduces health and welfare costs such as recurrent hospital admissions, and promotes a more productive labour force, indirectly stimulating economic growth.

WHO is also supporting the IPC and the Government of France to ensure a healthy and safe environment for all athletes and spectators at the Paris 2024 Paralympics. Joint public health advice, developed with the European Centre for Disease Prevention and Control, has been provided to support travellers attending the Games.

In an unprecedented show of unity in support of the World Health Organization, 14 African countries and many partners pledged over US$ 45 million to the WHO Investment Round, a three-month-old initiative aimed at generating sustainable financing for the organization at the center of the global health architecture.  The commitments were made during the World Health Organization (WHO) Regional Committee for Africa, with heads of state and government from across the continent underscoring the importance of investing in global health and ensuring a strong WHO. 

“I thank our African Region Member States for actively supporting WHO’s first Investment Round to mobilize predictable and flexible resources needed for our core work over the next four years,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Full, sustainable funding will enable WHO to support countries better in their work to build healthier, more resilient, and more prosperous populations.” 

The countries and partners came together for the historic event aimed at sustainably funding WHO and thus enabling it to more effectively fulfil its mandate and advance key objectives to promote, provide and protect health and well-being for all. The countries included Botswana, Cabo Verde, Chad, Congo, Ethiopia, Gambia, Mauritius, Namibia, Niger, Rwanda, Senegal, Seychelles, South Africa, and the United Republic of Tanzania.  

Many partners joined Members States in making commitments of support to WHO and committing to providing pledges later in the year, including Helmsley Charitable Trust, World Diabetes Foundation, Roche, Kuwait Fund for Arab Economic Development, the Bill & Melinda Gates Foundation, African Development Bank and the WHO Foundation.  

“A strong, predictable and sustainably financed WHO is essential for our region and the world to meet the multiple health threats we face; and support the prevention of disease based on the vast evidence at our disposal,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Every pledge and every partnership counts. Together, we can achieve a future where health and well-being are accessible to all.”  

The WHO Investment Round will continue in the coming months and feature key pledging moments around the world. Learn more about the WHO investment Round.  

Launched at the World Health Assembly in May 2024, the Investment Round aims to generate contributions that are flexible and thereby aligned with WHO’s strategy as approved by its Member States; predictably provided at the start of the four-year budget cycle to enable strategic decision-making; and resilient in that they will derive from a larger, more diverse set of donors.

The World Health Organization (WHO) today launched a global Strategic Preparedness and Response Plan to stop outbreaks of human-to-human transmission of mpox through coordinated global, regional, and national efforts. This follows the declaration of a public health emergency of international concern by the WHO Director-General on 14 August.

The current plan is subject to inputs by Member States, who were briefed on the plan on Friday, 23 August.

The plan covers the six-month period of September 2024-February 2025, envisioning a US$135 million funding need for the response by WHO, Member States, partners including Africa Centres for Disease Control and Prevention (Africa CDC), communities, and researchers, among others.

A funding appeal for what WHO needs to deliver on the plan will be launched shortly.

The plan, which builds on the temporary recommendations and standing recommendations issued by the WHO Director-General, focuses on implementing comprehensive surveillance, prevention, readiness and response strategies; advancing research and equitable access to medical countermeasures like diagnostic tests and vaccines; minimizing animal-to-human transmission; and empowering communities to actively participate in outbreak prevention and control.

Strategic vaccination efforts will focus on individuals at the highest risk, including close contacts of recent cases and healthcare workers, to interrupt transmission chains.

At the global-level, the emphasis is on strategic leadership, timely evidence-based guidance, and access to medical countermeasures for the most at-risk groups in affected countries.

WHO is working with a broad range of international, regional, national and local partners and networks to enhance coordination across key areas of preparedness, readiness and response. This includes engagement with the ACT-Accelerator Principals group; the Standing Committee on Health Emergency Prevention, Preparedness and Response; the R&D Blueprint for Epidemics; and the interim Medical Counter Measures Network (i-MCM Net).

The WHO R&D Blueprint, along with Africa CDC, Coalition for Epidemic Preparedness Innovations (CEPI) and National Institute of Allergy and Infectious Diseases, will host a virtual scientific conference on 29-30 August 2024 to align mpox research with outbreak control goals.

“The mpox outbreaks in the Democratic Republic of the Congo and neighbouring countries can be controlled, and can be stopped,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Doing so requires a comprehensive and coordinated plan of action between international agencies and national and local partners, civil society, researchers and manufacturers, and our Member States. This SPRP provides that plan, based on the principles of equity, global solidarity, community empowerment, human rights, and coordination across sectors.”

WHO headquarters and regional offices have established incident management support teams to lead preparedness, readiness and response activities, and are significantly scaling up staff in affected countries.

Within the Africa Region, where need is greatest, the WHO Regional Office for Africa (AFRO) in collaboration with Africa CDC, will jointly spearhead the coordination of mpox response efforts. WHO AFRO and Africa CDC have agreed on a one-plan, one-budget approach as part of the Africa Continental Mpox Strategic Preparedness and Response Plan, currently under preparation.

At the national and sub-national level, health authorities will adapt strategies in response to current epidemiological trends.

The Director-General of the World Health Organization (WHO), having concurred with the advice offered by the International Health Regulations (2005) (IHR or Regulations) Emergency Committee regarding the upsurge of mpox 2024 during its first meeting, held on 14 August 2024, has determined, on the same date, that the ongoing upsurge of mpox in the Democratic Republic of the Congo (DRC) and in a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the provisions of the Regulations. The communication of the Director-General regarding the determination of the above-mentioned PHEIC on 14 August 2024 is available here.

The Director-General is hereby transmitting the report of the first meeting of the IHR Emergency Committee regarding the upsurge of mpox 2024.

Noting that the Director-General will be communicating to States Parties a 12-month extension of the current standing recommendations for mpox, the temporary recommendations, issued by the Director-General in relation to the PHEIC associated with the ongoing upsurge of mpox are presented in the last section of this statement and reflect the advice offered by the Committee.

The Director-General is taking the opportunity to express his most sincere gratitude to the Chair, Vice-Chair, and Members of the IHR Emergency Committee, as well as to its Advisors. 

Proceedings of the meeting

Sixteen (16) Members of, and two Advisors to, the Emergency Committee were convened by teleconference, via Zoom, on Wednesday, 14 August 2024, from 12:00 to 17:00 CEST. Fifteen (15) of the 16 Committee Members and the two Advisors to the Committee participated in the meeting.

The Director-General of the World Health Organization (WHO) joined in person and welcomed the participants. The opening remarks by the Director-General are available here.

The Representative of the Office of Legal Counsel briefed the Members and Advisers on their roles and responsibilities and identified the mandate of the Emergency Committee under the relevant articles of the IHR. The Ethics Officer from the Department of Compliance, Risk Management, and Ethics provided the Members and Advisors with an overview of the WHO Declaration of Interests process. The Members and Advisors were made aware of their individual responsibility to disclose to WHO, in a timely manner, any interests of a personal, professional, financial, intellectual or commercial nature that may give rise to a perceived or actual conflict of interest. They were additionally reminded of their duty to maintain the confidentiality of the meeting discussions and the work of the Committee. Each Member and Advisor was surveyed, with no conflicts of interest identified.

The Representative of the Office of Legal Counsel then facilitated the election of officers of the Committee, in accordance with the rules of procedures and working methods of the Emergency Committee. Professor Dimie Ogoina was elected as Chair of the Committee, Professor Inger Damon as Vice-Chair, and Professor Lucille Helen Blumberg as Rapporteur, all by acclamation.

The meeting was handed over to the Chair who introduced the objectives of the meeting, which were to provide views to the Director-General on whether the event constitutes a public health emergency of international concern (PHEIC), and if so, to provide views on the potential proposed temporary recommendations.  

Session open to representatives of States Parties invited to present their views

The WHO Secretariat presented an overview of the global epidemiological situation of mpox, highlighting that, during the first six months of 2024, the 1854 confirmed cases of mpox reported by States Parties in the WHO African Region account for 36% (1854/5199) of the cases observed worldwide. Of these confirmed cases in the WHO African region in 2024, 95% (1754/1854) were reported in the Democratic Republic of the Congo (DRC), that is experiencing an upsurge of cases of mpox, with more than 15,000 clinically compatible cases and over 500 deaths reported, already exceeding the number of cases observed in the DRC in 2023.

The upsurge of mpox cases in the DRC is being driven by outbreaks associated with two sub-clades of clade I monkeypox virus (MPXV) – clade Ia and clade Ib. Clade I mpox was classically described in studies conducted by WHO in the 1980’s to have a mortality rate of approximately 10%, with most deaths occurring in children.

MPXV clade Ia is endemic in the DRC, the disease primarily affects children, data available for 2024 show an aggregated case fatality rate of 3.6%, and the spread is likely sustained through multiple modes of transmission including person-to-person transmission following zoonotic introduction in a community.

MPXV clade Ib is a new strain of MPXV that emerged in the DRC  is transmitting between people, presumed via sexual contact, which has been spreading in the eastern part of the country. Although first characterized in 2024, estimates suggest it emerged around September 2023. The outbreak associated with clade Ib in the DRC primarily affects adults and is spreading rapidly, sustained largely, but not exclusively, through transmission linked to sexual contact and amplified in networks associated with commercial sex and sex workers.

Since July 2024, cases of mpox due to MPXV clade Ib, epidemiologically and phylogenetically linked to the outbreak in the eastern provinces of DRC, have been detected in four countries, neighbouring the DRC, which had not reported cases of mpox before: Burundi, Kenya, Rwanda and Uganda.

Additionally, in 2024, cases of mpox linked to MPXV clade Ia have been reported in the Central African Republic and the Republic of Congo, and cases linked to MPXV clade II have been reported in Cameroon, Côte d’Ivoire, Liberia, Nigeria and South Africa.

The clinical presentation of mpox associated with MPXV clade Ia has historically been characterized by more severe disease than that associated with MPXV clade II. Clade IIb viruses circulated during the multi-country outbreak that constituted a PHEIC from July 2022 to May 2023. There is, as yet, insufficient information available to fully characterize mpox severity due to clade Ib as data are emerging and, so far, few deaths were recorded, precluding age-stratified analyses.

The secretariat outlined challenges in understanding the true extent of infection, epidemiologic trends and morbidity and mortality, thus cautioning overinterpretation of available data to calculate crude CFRs by different clades/outbreaks.

The assessed risk presented by the WHO Secretariat – grouping geographical areas as a result of the assessment of population groups affected, predominant modes of transmission, and MPXV clades involved –, was: “high” for eastern DRC and neighbouring countries; “high” for areas of the DRC where mpox is known to be endemic; “moderate” for Nigeria and countries of West, Central and East Africa where mpox is endemic; and “moderate” for other countries in Africa and around the world.

The WHO Secretariat additionally provided an overview of the actions already taken to support readiness and response interventions in States Parties experiencing the upsurge of cases of mpox and facing such risk. These include, inter alia: the release of USD 1.45 million from the WHO Contingency Fund for Emergencies; initiating the process for including Emergency Use Listing two mpox vaccines; coordinating with partners and stakeholders, including to facilitate equitable access to vaccines, therapeutics, and diagnostics; the development of a regional response plan, costed at an initial USD 15 million, and more.

Representatives of Burundi, the Democratic Republic of the Congo, Kenya, Rwanda, South Africa and Uganda updated the Committee on the mpox epidemiological situation in their countries and the current response efforts, needs and challenges. Although most reported few cases of MPXV clade Ib related mpox, Burundi reported one hundred confirmed cases of mpox associated with clade Ib since July 2024, identified in multiple districts and 28% of cases were amongst children less than five years of age.

Members of, and Advisors to, the Committee then engaged in questions and answers with the presenters. The questions and discussions focused around the issues and challenges enumerated below:

• The observed complex and dynamic evolution of the multiple outbreaks driving the upsurge of mpox, and related international spread, of mpox in the DRC and neighbouring countries. Elements underpinning such observation, and representing reasons for concern, including:
  • Scientific uncertainties and evidence gaps (e.g., role of ecological changes in the spread of mpox, modes of disease transmission, transmission dynamics, risk factors, disease severity and case fatality rate associated with the different MPXV clades, outcome of pregnancy in women infected with different MPXV clades);
  • Adequacy of capacities, recognizing capacities gained during COVID-19, and heterogeneity thereof, across States Parties for surveillance, diagnostic capacities, surveillance modalities at borders, access to clinical care, integration of HIV/STI services in prevention and treatment, and risk communication and community engagement, vaccination delivery, and other capacities to support prevention, readiness and response activities;
  • Lack of full understanding of the geographical spread and detailed epidemiology of the dynamic mpox outbreaks, including of molecular epidemiology, to optimize targeted prevention and control measures, including risk communication and community engagement with local partners to enable appropriate support and behavior modifications, as well as the targeted use of mpox vaccines in at risk groups;
  • Availability and access to laboratory tests that can be used in challenging environments, and where necessary, methods to distinguish between circulating MPXV clades; and
  • An incomplete mapping of mpox-related research and development efforts underway, noting several initiatives underway, including a WHO and Africa Centers for Disease Control and Prevention (Africa CDC) consultation to be held in August 2024;
• The unpredictability and lack of financial resources at both, national and international levels to scale up and sustain interventions to prevent and control the spread of mpox, despite the development of costed global, regional and national response plans;
• The needs-based access to mpox vaccines, given the current limited available globally; the currently limited production of the vaccine, conditional to orders placed to the manufacturer; and the extensive time to develop legal agreements in relation to donation of mpox vaccines, as opposed to direct procurement. With respect to access to vaccines, the WHO Secretariat informed the Committee of its ongoing work with numerous partners through the Interim coordination mechanism for medical countermeasures (i-MCM-Net), including Gavi and the United Nations Children's Fund on the coordination of the donation and allocation process in an equitable, needs-based manner;
• The access to the antiviral drug tecovirimat, considering that both, the minimum amount for orders to be placed with the manufacturer and the price of the product represent key challenges for many States Parties. While evidence is being gathered on its use for the treatment of cases of mpox, it can be accessed under protocol for Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI); and
• The need for information on the implementation, by States Parties, of the standing recommendation for mpox issued on 21 August 2023.

Deliberative session

Following the session open to invited States Parties, the Committee reconvened in a closed session to examine the questions in relation to whether the event constitutes a PHEIC or not, and if so, to consider the temporary recommendations drafted by the WHO Secretariat in accordance with IHR provisions.

The Chair reminded the Committee Members of their mandate and recalled that a PHEIC is defined in the IHR as an “extraordinary event, which constitutes a public health risk to other States through the international spread of disease, and potentially requires a coordinated international response”.

The Committee was unanimous in expressing the views that the ongoing upsurge of mpox meets the criteria of a PHEIC and that the Director-General be advised accordingly.

The considerations underpinning the unanimous views of the Committee further elaborated upon issues and challenges addressed during the question and answers session.

The Committee considered the event as “extraordinary” because of (a) the increase in mpox clade I disease occurrence in the DRC and the emergence of the new MPXV clade Ib, the human-to-human transmission context in which it is occurring, its rapid spread in some settings, and available evidence suggesting that MPXV clade I is associated with a more severe clinical presentation with respect to MPXV clade II; (b) the diverse, complex, dynamic, and rapidly evolving epidemiology observed across States Parties in the WHO African Region in terms of: overall rapid increase of the number of cases reported in some settings, differences in population age-groups affected, routes and modes sustaining transmissions in different contexts; and (c) the severity of the clinical presentation in children and immunocompromised individuals, including people living with uncontrolled HIV infection or advanced HIV disease, as well as the long-term consequences of MPXV infection.

Additionally, the Committee strongly underscored that its level of concern is further heightened by (a) uncertainties and gaps in knowledge and evidence related to (i) multiple epidemiological aspects, including drivers of transmission, morbidity and mortality associated with infections with different MPXV sub-clades; (ii) the incompleteness and uncertainties of available epidemiological data and considered by the Committee, due to the limitations of current surveillance (e.g., sub-optimal levels of case detection and case reporting), the availability and performance of laboratory diagnostics, and ongoing conflicts and humanitarian challenges in certain areas of the DRC experiencing the upsurge of mpox, that, ultimately, hamper the implementation of control measures; (iii) the impact of control measures, including the targeted use of vaccines and their overall effectiveness; and (b) the risk of occurrence of additional mutations of MPXV clade I and clade II, and their subsequent emergence and spread in the context of limited capacity to implement control measures.

The Committee considered that the event “constitutes a public health risk to other States through the international spread of disease” because of (a) the documented recent spread of MPXV clade Ib from eastern DRC to Burundi, Kenya, Rwanda and Uganda; (b) the limited capacity to control transmission in endemic situations and in areas of upsurge through enhanced surveillance enabling the implementation of targeted response interventions that are ultimately subordinated to (i) the unavailability of sustainable funding, and (ii) the limited ability to access vaccines, therapeutics, and diagnostics; and (c) the challenges in implementing concerted surveillance and response interventions in contiguous areas of bordering States Parties, in particular where borders are porous.

The Committee considered that the event “requires a coordinated international response”. The Committee noted that (a) mpox is endemic in parts of Africa, with surges increasingly reported, and also resulting in a multi-country outbreak determined to constitute a PHEIC in 2022-2023; and (b) the event is occurring in the context of standing recommendations issued by the Director-General in August 2023 under IHR provisions and following the termination of the afore mentioned PHEIC; the presence of the “WHO Strategic framework for enhancing prevention and control of mpox- 2024-2027”; and the activation for mpox of the i-MCM-Net. In that light and noting the declaration of the event as a Public Health Emergency of Continental Security by the Africa CDC on 13 August 2024, the Committee considered that international cooperation requires enhanced and coordination, in particular with respect to (a) the facilitation of equitable access to vaccines, therapeutics, and diagnostics; and (b) the mobilization of financial resources.

The Committee subsequently considered the draft of the temporary recommendations proposed by the WHO Secretariat, briefly presented during the meeting. The Committee indicated that it would be giving further consideration to the proposed temporary recommendations while finalizing the report of the meeting.

The Committee noted that, in his opening remarks, the Director-General communicated the 12-month extension of the current standing recommendations for mpox, which were set to expire on 20 August 2024. The Committee also noted that, should the Director-General determine that the upsurge of mpox constitutes a PHEIC, it would be the first time, since the entry into force of the Regulations, that temporary and standing recommendations to States Parties related to the same public health risk would coexist.

Therefore, the Committee underscored that any temporary recommendation that may be issued by the Director-General should be very specific and targeted, and hence, not duplicate the standing recommendations.

Notwithstanding that both, temporary and standing recommendations constitute non-binding advice to States Parties, the Committee advised that mechanisms to monitor the uptake, implementation and impact of such recommendations should be embedded in the set of temporary recommendations to States Parties that the Director-General may issue in relation to the event considered.

Conclusions

The Committee reiterated its concern regarding the evolution of the multi-faceted upsurge of mpox, including the many uncertainties surrounding it and the capacities in place to control the spread of mpox in States Parties experiencing the outbreaks, or in States Parties that may have to do so as a result of further international spread.

The Committee recognized the critical role of coordinated international cooperation in supporting States Parties’ efforts to control the spread of mpox in the WHO African Region – including in facilitating access to and use of vaccines, therapeutics, and diagnostics; mobilizing financial resources for States Parties experiencing the upsurge of disease; and synergic initiatives by WHO and partners, including Africa CDC.

Nevertheless, the Committee indicated that the development of strategic approaches for States Parties to become more self-reliant in controlling the spread of mpox are warranted. To that effect, the Committee considers that the determination by the Director-General that the upsurge of mpox constitutes a PHEIC would stimulate States Parties facing the outbreaks to more effectively commit and employ domestic resources. 

Temporary recommendations issued by the Director-General of the World Health Organization (WHO) to States Parties in relation to the public health emergency of international concern associated with the upsurge of mpox 

These temporary recommendations are issued to States Parties experiencing the upsurge of mpox, including, but not limited to, the Democratic Republic of the Congo and Burundi, Kenya, Rwanda, and Uganda.

They are intended to be implemented by those States Parties in addition to the current standing recommendations for mpox, which will be extended until 20 August 2025 and are presented at the end of this document for easy reference. 

In the context of the global efforts to prevent and control the spread of mpox disease outlined in the WHO Strategic framework for enhancing prevention and control of mpox- 2024-2027, the aforementioned standing recommendations apply to all States Parties. 

All current WHO interim technical guidance can be accessed on this page of the WHO website. WHO evidence-based guidance has been and will continue to be updated in line with the evolving situation, updated scientific evidence, and WHO risk assessment to support States Parties in the implementation of the WHO Strategic Framework for enhancing mpox prevention and control. 

Pursuant to Article 3 Principle of the International Health Regulations (2005) (IHR), the implementation of these temporary recommendations, as well as of the standing recommendations for mpox, by States Parties shall be with full respect for the dignity, human rights and fundamental freedoms of persons, in line with the principles set out in Article 3 of the IHR. 

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 Emergency Coordination

• Establish or enhance national and local emergency response coordination arrangements;
• Establish or enhance the coordination of all partners and stakeholders engaged in or supporting response activities through cooperation, including by introducing accountability mechanisms;
• Engage partner organizations for collaboration and support, including humanitarian actors in contexts with insecurity or areas with internal or refugee population displacements and hosting communities insecure areas;

Collaborative Surveillance and Laboratory Diagnostics

• Enhance surveillance, by increasing the sensitivity of the approaches adopted and ensuring comprehensive geographical coverage;
• Expand access to accurate, affordable and available diagnostics to differentiate monkeypox virus clades, including through strengthening arrangements for the transport of samples, the decentralization of diagnostics, and arrangements to conduct genomic sequencing;
• Identify, monitor and support the contacts of people with mpox to prevent onward transmission;
• Scale up efforts to thoroughly investigate cases and outbreaks of mpox disease to elucidate the modes of transmission, and prevent its onward transmission to household members and communities;
• Report to WHO suspect, probable and confirmed cases of mpox in a timely manner and on a weekly basis;

Safe and Scalable Clinical Care

• Provide clinical, nutritional and psychosocial support for patients with mpox, including, as warranted and possible, isolation in care centres and guidance for home-based care;
• Develop and implement a plan to expand access to optimised supportive clinical care for all patients with mpox, including children, patients living with HIV and pregnant women. This includes offering HIV tests to adult patients who do not know their HIV status and to children as appropriate, with linkages to HIV treatment and care services when indicated; the prompt identification and effective management of endemic co-infections, such as malaria, varicella zoster and measles viruses, and other sexually transmitted infections (STIs) among cases linked to sexual contact;
• Strengthen health and care workers’ capacity, knowledge and skills in the clinical and infection and prevention and control pathways –from diagnosis to discharge of patients with suspected and confirmed mpox –, and provide them with personal protective equipment;
• Promote and implement infection prevention and control measures and basic water and sanitation services in health care facilities, household settings, congregate settings (e.g. prisons, internally displaced persons and refugee camps, schools, etc.), and cross border transit areas;

International traffic

• Establish or strengthen cross-border collaboration arrangements for surveillance and management of suspect cases of mpox, the provision of information to travellers and conveyance operators, without resorting to general travel and trade restrictions unnecessarily impacting local, regional or national economies;

Vaccination

• Prepare for the introduction of mpox vaccine for emergency response through convening of national immunization technical advisory groups, briefing of national regulatory authorities, preparing national policy mechanisms to apply for vaccines through available mechanisms;
• Initiate plans to advance mpox vaccination activities in the context of outbreak response in areas with incident cases (i.e. with disease onset in the previous 2-4 weeks), targeting people at high risk of infection (e.g., contacts of cases, including sexual contacts, children, and health and health care workers). This entails the agile adaptation of immunization strategies and plans to concerned areas; the availability of vaccines and supplies; the proactive community engagement, to generate and sustain demand for and trust in vaccination; and the collection of data during vaccination according to implementable research protocols;

Risk communication and community engagement

• Strengthen risk communication and community engagement systems with affected communities and local workforces for outbreak prevention, response and vaccination strategies, including through training, mapping high risk and vulnerable populations, social listening and community feedback, managing misinformation. This entails, inter alia, communicating effectively the uncertainties regarding the natural history of mpox, updated information about mpox including information from ongoing clinical trials, about the efficacy of vaccines against mpox, and the uncertainties regarding duration of protection following vaccination;
• Address stigma and discrimination of any kind via meaningful community engagement, particularly in health services and during risk communication activities;

Governance and financing

• Galvanize and scale up national funding and explore external opportunities for targeted funding of prevention, readiness and response activities;
• Integrate mpox prevention and response measures in existing programmes aimed at prevention, control and treatment of other endemic diseases – especially HIV, as well as STIs, malaria, tuberculosis, and COVID-19, as well as non-communicable diseases –, striving, to the extent possible, not to negatively impact their delivery;

Addressing research gaps

• Invest in addressing knowledge gaps and in generating evidence, during and after outbreaks, regarding the dynamics of transmission of mpox, risk factors, the social and behavioural drivers of transmission, the natural history of disease, through trials for novel therapeutics and vaccines against mpox, the effectiveness of public health interventions, with a One Health approach;

Reporting on the implementation of temporary recommendations

• Report quarterly to WHO on the status of, and challenges related to the implementation of these temporary recommendations, using a standardized tool and channels that will be made available WHO.

Standing recommendations for mpox issued by the Director-General of the World Health Organization (WHO) in accordance with the International Health Regulations (2005) (IHR)

A. States Parties are recommended to develop and implement national mpox plans that build on WHO strategic and technical guidance, outlining critical actions to sustain control of mpox and achieve elimination of human-to-human transmission in all contexts through coordinated and integrated policies, programmes and services. Actions are recommended to:

1. Incorporate lessons learned from evaluation of the response (such as through intra- or after-action reviews) into related plans and policies in order to sustain, adapt, and promote key elements of the response and inform public health policies and programmes.
2. Aim to eliminate human-to-human transmission of mpox by anticipating, detecting, preparing for and responding to mpox outbreaks and taking action to reduce zoonotic transmission, as appropriate.
3. Build and retain capacity in resource-limited settings, and among marginalized groups, where mpox transmission continues to occur, to improve understanding of modes of transmission, quantify resource needs, and detect and respond to outbreaks and community transmission.

B. States Parties are recommended to, as a critical basis for actions outlined in A in support of the elimination goal, establish and sustain laboratory-based surveillance and diagnostic capacities to enhance outbreak detection and risk assessment. Actions are recommended to:

4. Include mpox as a notifiable disease in the national epidemiological surveillance system.

5. Strengthen diagnostic capacity at all levels of the health care system for laboratory and point of care diagnostic confirmation of cases.

6. Ensure timely reporting of cases to WHO, as per WHO guidance and Case Reporting Form, in particular reporting of confirmed cases with a relevant recent history of international travel.

7. Collaborate with other countries so that genomic sequencing is available in, or accessible to, all countries. Share genetic sequence data and metadata through public databases.

8. Notify WHO about significant mpox-related events through IHR channels.

C. States Parties are recommended to enhance community protection through building capacity for risk communication and community engagement, adapting public health and social measures to local contexts and continuing to strive for equity and build trust with communities through the following actions, particularly for those most at risk. Actions are recommended to:

9. Communicate risk, build awareness, engage with affected communities and at-risk groups through health authorities and civil society.

10. Implement interventions to prevent stigma and discrimination against any individuals or groups that may be affected by mpox.

D. States Parties are recommended to initiate, continue, support, and collaborate on research to generate evidence for mpox prevention and control, with a view to support elimination of human-to-human transmission of mpox. Actions are recommended to:

11. Contribute to addressing the global research agenda to generate and promptly disseminate evidence for key scientific, social, clinical, and public health aspects of mpox transmission, prevention and control.

12. Conduct clinical trials of medical countermeasures, including diagnostics, vaccines and therapeutics, in different populations, in addition to monitoring of their safety, effectiveness and duration of protection.

13. States Parties in West, Central and East Africa should make additional efforts to elucidate mpox-related risk, vulnerability and impact, including consideration of zoonotic, sexual, and other modes of transmission in different demographic groups.

E. States Parties are recommended to apply the following measures related to international travel. Actions are recommended to:

14. Encourage authorities, health care providers and community groups to provide travelers with relevant information to protect themselves and others before, during and after travel to events or gatherings where mpox may present a risk.

15. Advise individuals suspected or known to have mpox, or who may be a contact of a case, to adhere to measures to avoid exposing others, including in relation to international travel.

16. Refrain from implementing travel-related health measures specific for mpox, such as entry or exit screening, or requirements for testing or vaccination.

F. States Parties are encouraged to continue providing guidance and coordinating resources for delivery of optimally integrated clinical care for mpox, including access to specific treatment and supportive measures to protect health workers and caregivers as appropriate. States Parties are encouraged to take actions to:

17. Ensure provision of optimal clinical care with infection prevention and control measures in place for suspected and confirmed mpox in all clinical settings. Ensure training of health care providers accordingly and provide personal protective equipment.

18. Integrate mpox detection, prevention, care and research within HIV and sexually transmitted disease prevention and control programmes, and other health services as appropriate.

G. States Parties are encouraged to work towards ensuring equitable access to safe, effective and quality-assured countermeasures for mpox, including through resource mobilization mechanisms. States Parties are encouraged to take action to:

19. Strengthen provision of and access to diagnostics, genomic sequencing, vaccines, and therapeutics for the most affected communities, including in resource-constrained settings where mpox occurs regularly, and including for men who have sex with men and groups at risk of heterosexual transmission, with special attention to those most marginalized within those groups.

20. Make mpox vaccines available for primary prevention (pre-exposure) and post-exposure vaccination for persons and communities at risk of mpox, taking into account recommendations of the WHO Strategic Advisory Group of Experts on Immunization (SAGE).

Two rounds of a polio vaccination campaign are expected to be launched at the end of August and September 2024 across the Gaza Strip to prevent the spread of circulating variant type 2 poliovirus (cVDPV2).  

WHO and UNICEF request all parties to the conflict to implement humanitarian pauses in the Gaza Strip for seven days to allow for two rounds of vaccination campaigns to take place. These pauses in fighting would allow children and families to safely reach health facilities and community outreach workers to get to children who cannot access health facilities for polio vaccination. Without the humanitarian pauses, the delivery of the campaign will not be possible. 

During each round of the campaign, the Palestinian Ministry of Health (MoH), in collaboration with the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) and partners, will provide two drops of novel oral polio vaccine type 2 (nOPV2) to more than 640 000 children under ten years of age.  

The poliovirus was detected in July 2024 in environmental samples from Khan Younis and Deir al-Balah. Worryingly, three children presenting with suspected acute flaccid paralysis (AFP), a common symptom of polio, have since been reported in the Gaza Strip. Their stool samples have been sent for testing to the Jordan National Polio Laboratory. 

Over 1.6 million doses of nOPV2, which is used to stop cVDPV2 transmission, will be delivered to the Gaza Strip. The deliveries of the vaccines and the cold chain equipment are expected to transit through Ben Gurion Airport before arriving in the Gaza Strip by the end of August. It is essential that the transport of the vaccines and cold chain is facilitated at every step of the journey to ensure their timely reception, clearance and ultimately delivery in time for the campaign. 

Detailed plans to support vaccinators and social mobilizers to reach eligible children across the Gaza Strip have been finalized. Vaccination will be administered by 708 teams, including at hospitals, field hospitals, and primary health care centres in each municipality of the Gaza Strip. Around 2700 health workers, including mobile teams and community outreach workers, will support the delivery of both rounds of the campaign. This will be supported by awareness-raising efforts to mitigate the risks of polio infection.   

At least 95 per cent vaccination coverage during each round of the campaign is needed to prevent the spread of polio and reduce the risk of its re-emergence, given the severely disrupted health, water and sanitation systems in the Gaza Strip. 

Other requirements for successful campaign delivery include sufficient cash, fuel and functional telecommunication networks to reach communities with information about the campaign.  

Further efforts are underway to strengthen and expand poliovirus surveillance and routine immunization.  

The Gaza Strip has been polio-free for the last 25 years. Its reemergence, which the humanitarian community has warned about for the last ten months, represents yet another threat to the children in the Gaza Strip and neighboring countries.  A ceasefire is the only way to ensure public health security in the Gaza Strip and the region.   

Notes for editors  

• On 16 July 2024, wastewater test results confirmed that cVDPV2 was detected in six samples collected on 23 June 2024 from Khan Younis and Deir al Balah ES sites in the Gaza Strip. Further sequencing analysis confirmed that these cVDPV2 isolates are linked to a variant poliovirus strain last detected in Egypt in 2023.    

• The Gaza Strip had a high level of vaccination coverage across the population before the escalation of hostilities in October 2023. However, due to the impact of the conflict, routine immunization coverage (for the second dose of inactivated polio vaccine) dropped from 99 per cent in 2022 to less than 90 per cent in the first quarter of 2024, increasing the risk of vaccine-preventable diseases to children, including polio.   

• The risk of cVDPV2 spread, within the Gaza Strip and internationally, remains high given gaps in children's immunity due to disruptions in routine vaccination, decimation of the health system, constant population displacement, malnutrition and severely damaged water and sanitation systems. The situation has also increased the risk of the spread of other vaccine-preventable diseases such as measles as well as cases of diarrhoea, acute respiratory infections, hepatitis A and skin diseases among children.