The monkeypox epidemic is progressing. Nearly 17,000 cases have been identified in 74 countries, according to the latest figures from the World Health Organization (WHO). Detected in early May, the unusual upsurge in monkeypox cases outside central and western African countries where the virus is endemic has since spread across the globe, with Europe as its epicenter.

If Tedros Adhanom Ghebreyesus, the director of the WHO, specified that the risk in the world was relatively moderate, except in Europe where it is high, the UN institution determined, this Saturday July 23, that the current outbreak cases constituted a public health emergency of international concern, its highest level of alert. But what is it exactly?

The public health emergency of international concern (USPPI) is declared by the World Health Organization (WHO) and must meet specific criteria. For the WHO, this level of maximum alert in terms of international public health can only be decided in response to “an extraordinary event which is determined to constitute a risk for public health in other States in because of the international risk of disease spread”. The objective is to be able to mobilize coordinated international action to try to stop the disease in question, or at least to curb it.

Moreover, a public health emergency of international concern does not only concern infectious diseases, it can be triggered following events caused by chemical or radioactive agents.

The decision is taken in compliance with the legal framework of the “international health regulations”. An agreement ratified in 2005 by 196 countries. The health problem posed must be “serious”, “sudden”, “unusual” or “unexpected”. It must “have repercussions for public health beyond the national borders of the affected state in such a way as to” require immediate international action, “explains the WHO.

In addition, the verdict of such a decision depends on the scientific data collected, data concerning the evolution of the epidemic, its mode of transmission, its dangerousness as well as the opinion of an emergency committee. However, the emergency committee can sometimes be divided and delay the establishment of this health emergency of international concern. This had been the case at the end of 2019 when the Covid-19 epidemic appeared in China. Ultimately, only the director of the WHO can act on this maximum level of alert.

From the moment the alert is triggered, the emergency committee set up to assess the situation at the outset must meet every three months in order to issue recommendations at international and national level for the most affected. They generally concern the movement of populations by addressing ports, airports and trains as well as border crossings.

In January 2020, shortly before declaring the USPPI in connection with the Covid-19 outbreak, the assessment committee had indicated that a “public health emergency of international concern is an important step in the history of an epidemic” and that “the perception of such a decision on an international scale was part of the elements to be taken into account”.

As its name suggests, the USPPI is an exceptional emergency measure. It has thus been decreed only six times by the WHO since its creation. The first time was in 2009 during the influenza A (H1N1) pandemic, then in May 2014 for Ebola, and in August of the same year for Poliomyelitis. In 2016, the alert was given with the appearance of Zika. Then in 2019, Ebola again focused concerns after contaminations in the Democratic Republic of Congo, which killed more than 2,000 people.

Finally, the last alert given, in January 2020, concerned the outbreak of sick cases linked to the Covid-19 epidemic all over the world. On July 8, a meeting of the evaluation committee was held for the twelfth time in Geneva since the start of the pandemic. Following which, the WHO Director-General endorsed the advice given by the Committee regarding the current Covid-19 pandemic and “determined that the event continues to constitute a public health emergency of international concern (USPPI )”.