As the World Health Organization convenes its emergency committee Thursday to consider if the spiraling outbreak of monkeypox warrants being declared a global emergency, some experts say WHO’s decision to act only after the disease spilled into the West could entrench the grotesque inequities that arose between rich and poor countries during the coronavirus pandemic.
Declaring monkeypox to be a global emergency would mean the U.N. health agency considers the outbreak to be an “extraordinary event” and that the disease is at risk of spreading across even more borders. It would also give monkeypox the same distinction as the COVID-19 pandemic and the ongoing effort to eradicate polio.
Many scientists doubt any such declaration would help to curb the epidemic, since the developed countries recording the most recent cases are already moving quickly to shut it down.
Last week, WHO Director-General Tedros Adhanom Ghebreyesus described the recent monkeypox epidemic identified in more than 40 countries, mostly in Europe, as “unusual and concerning.” Monkeypox has sickened people for decades in central and west Africa, where one version of the disease kills up to 10% of people. In the epidemic beyond Africa so far, no deaths have been reported.
“If WHO was really worried about monkeypox spread, they could have convened their emergency committee years ago when it reemerged in Nigeria in 2017 and no one knew why we suddenly had hundreds of cases,” said Oyewale Tomori, a Nigerian virologist who sits on several WHO advisory groups. “It is a bit curious that WHO only called their experts when the disease showed up in white countries,” he said.
Until last month, monkeypox had not caused sizeable outbreaks beyond Africa. Scientists haven’t found any major genetic changes in the virus and a leading adviser to WHO said last month the surge of cases in Europe was likely tied to sexual activity among gay and bisexual men at two raves in Spain and Belgium.
To date, the U.S. Centers for Disease Control and Prevention has confirmed more than 3,300 cases of monkeypox in 42 countries where the virus hasn’t been typically seen. More than 80% of cases are in Europe. Meanwhile, Africa has already seen more than 1,400 cases this year, including 62 deaths.
David Fidler, a senior fellow in global health at the Council on Foreign Relations, said WHO’s newfound attention to monkeypox amid its spread beyond Africa could inadvertently worsen the divide between rich and poor countries seen during COVID-19.
“There may be legitimate reasons why WHO only raised the alarm when monkeypox spread to rich countries, but to poor countries, that looks like a double standard,” Fidler said. He said the global community was still struggling to ensure the world’s poor were vaccinated against the coronavirus and that it was unclear if Africans even wanted monkeypox vaccines, given competing priorities like malaria and HIV.
“Unless African governments specifically ask for vaccines, it might be a bit patronizing to send them because it’s in the West’s interest to stop monkeypox from being exported,” Fidler said.
WHO has also proposed creating a vaccine-sharing mechanism to help affected countries, which could see doses go to rich countries like Britain, which has the biggest monkeypox outbreak beyond Africa — and recently widened its use of vaccines.
To date, the vast majority of cases in Europe have been in men who are gay or bisexual, or other men who have sex with men, but scientists warn anyone in close contact with an infected person or their clothing or bedsheets is at risk of infection, regardless of their sexual orientation. People with monkeypox often experience symptoms like fever, body aches and a rash; most recover within weeks without needing medical care.
Even if WHO announces monkeypox is a global emergency, it’s unclear what impact that might have.
In January 2020, WHO declared that COVID-19 was an international emergency. But few countries took notice until March, when the organization described it as a pandemic, weeks after many other authorities did so. WHO was later slammed for its multiple missteps throughout the pandemic, which some experts said might be prompting a quicker monkeypox response.
“After COVID, WHO does not want to be the last to declare monkeypox an emergency,” said Amanda Glassman, executive vice president at the Center for Global Development. “This may not rise to the level of a COVID-like emergency, but it is still a public health emergency that needs to be addressed.”
Salim Abdool Karim, an epidemiologist and vice chancellor at the University of KwaZulu-Natal in South Africa, said WHO and others should be doing more to stop monkeypox in Africa and elsewhere, but wasn’t convinced that a global emergency declaration would help.
“There is this misplaced idea that Africa is this poor, helpless continent, when in fact, we do know how to deal with epidemics,” said Abdool Karim. He said that stopping the outbreak ultimately depends on things like surveillance, isolating patients and public education.
“Maybe they need vaccines in Europe to stop monkeypox, but here, we have been able to control it with very simple measures,” he said.
President Joe Biden visited a vaccination clinic Tuesday to celebrate that virtually all Americans can now get a COVID-19 shot Tuesday after the authorization of vaccines for kids under 5 over the weekend.
Biden visited a vaccination clinic in Washington, where some of the first shots were given to young children in the last major age group ineligible for vaccines, hailing it as an important pandemic milestone that will support the country’s recovery. While anyone aged six months and up is now eligible for vaccines, the administration is cautioning that it expects the pace of shots for the youngest kids to be slower than older ones, as parents are more likely to rely on their children’s pediatricians to administer them.
“We’re the only country in the world doing this right now,” Biden said, as he and first lady Jill Biden met with newly vaccinated kids and their parents at Church of the Holy Communion in southeast Washington. As he handed out hugs to kids, Biden spoke of his youngest grandson, Beau, aged two, being newly eligible for vaccination.
“Everybody knows I like kids better than people,” he joked.
In a Friday interview with the AP White House COVID-19 coordinator Dr. Ashish Jha predicted that universal eligibility for vaccines would be a “huge psychological milestone” for the country as it seeks to emerge from two years of pandemic disruption.
“When the President came into office, he was very clear, he said over and over again, that he wanted to make sure that every American had the access and availability of these life protecting vaccines,” he said. “We are now at the point where that vision, that expectation that mission can now be fulfilled.”
A United Nations summit on biodiversity will be held in Canada instead of China, organizers announced Tuesday, the second major international event to be moved from China because of its strict anti-coronavirus policies.
China’s environment ministry said the meeting will be held in December in Montreal, where the secretariat for the summit organization is based. The ministry said in a statement that the decision was made “after comprehensively considering the pandemic situation at home and abroad.”
China withdrew last month as host of soccer’s 2023 Asian Cup. It has also indefinitely postponed the 2022 Asian Games, a sporting competition that was scheduled for September in the city of Hangzhou.
The country has stuck to a strict “zero-COVID” policy that has limited international visitors and repeatedly locked down parts or all of cities to stamp out any outbreak. The approach is increasingly at odds with other major countries that have loosened restrictions and moved toward living with the disease.
The biodiversity summit is similar to the more well-known U.N. climate summit. Countries that have joined a global agreement on preserving the world’s plant and animal species meet regularly to try to achieve the goals laid out in the pact.
China will continue to serve as president of the upcoming summit and the theme and logo will remain unchanged, the environment ministry said.
Beijing, the Chinese capital, hosted the Winter Olympics in February by creating a bubble that kept participants isolated from the general population in China.
It’s only been a month since North Korea acknowledged having an COVID-19 outbreak, after steadfastly denying any cases for more than two years. But already it may be preparing to declare victory.
According to state media, North Korea has avoided the mass deaths many expected in a nation with one of the world’s worst health care systems, little or no access to vaccines, and what outsiders see as a long record of ignoring the suffering of its people.
Daily updates from official media make it appear inevitable that the nation will completely defeat a virus that has killed more than 6 million people around the world. According to the official tally, cases are plummeting, and, while 18% of the nation of 26 million people reportedly have had symptoms that outsiders strongly suspect were from COVID=19, less than 100 have died.
The South Korean government as well as some experts believe that North Korea may soon declare that it has beaten the virus, linked, of course, to leader Kim Jong Un’s strong and clever guidance.
A victory lap, however, isn’t a foregone conclusion. Doing so, according to some experts, would deprive Kim of a useful tool to control the public and possibly open the government up to humiliation if cases continue.
“There are two sides to such a declaration,” said Moon Seong Mook, an analyst with the Seoul-based Korea Research Institute for National Strategy. “If North Korea says that COVID-19 has gone, it can emphasize that Kim Jong Un is a great leader who has overcome the pandemic. But in doing so, it can’t maintain the powerful restrictions that it uses to control its people in the name of containing COVID-19.”
Outsiders suspect that Kim is using the outbreak to boost internal unity at a time when many of his people are tired of 2 ½ years of draconian curbs that have hurt their livelihoods.
However North Korea deals with its description of the pandemic, many signs, at least in public statements, point to a declaration of a stunning success in dealing with a virus that has confounded the richest countries in the world.
In the initial stage of the outbreak, Kim described a “great upheaval” as daily fever cases — North Korea rarely calls them COVID-19, presumably because it lacks test kits — reached about 400,000. Now, however, the leader is suggesting that the outbreak has peaked, with his health officials maintaining a widely disputed fatality rate of 0.002%, the lowest in the world.
The question many outside experts are wrestling with is: What is the true state of misery in North Korea, which has banned nearly all outside journalists, aid workers and diplomats since early 2020?
North Korea is widely believed to be manipulating its true death toll to prevent any harm to Kim. It might also have exaggerated the number of earlier fever cases to boost vigilance against the virus and draw stronger public support for authorities’ anti-virus controls. North Korea has recently reported about 17,000 to 30,000 new fever cases each day, for a total of 4.7 million. It says — to widespread outside disbelief — that only 73 have died.
Whatever the real situation is, outside monitoring groups say they haven’t detected signs of anything catastrophic in North Korea.
“If a large number of people had died, there would have been some pieces of evidence, but there hasn’t been any,” said Nam Sung-wook, a professor at Korea University in South Korea. During a huge famine in the 1990s, for instance, rumors of widespread death and of people abandoning bodies spread outside of the country, into China and South Korea.
Kang Mi-jin, a North Korean defector in Seoul who runs a company analyzing the North’s economy, said three of her contacts in the northern North Korean city of Hyesan told her during phone calls that most of their family members have suffered suspected COVID-19 symptoms. But she said they told her that none of their relatives, neighbors and acquaintances has died of COVID-19, though they’ve heard rumors of such deaths in other towns.
“During an earlier phone conversation, one of my sources cried a little bit when she said she was worried that some bad things could happen in her family (because of COVID-19). But now she and others have become stable and sometimes laugh when we talk on the phone,” Kang said.
During a recent ruling party meeting, Kim said the country’s pandemic fight has passed the stage of “unexpected serious crisis.” State media have urged the public to rally behind Kim in a firmer way to overcome the pandemic completely.
Cho Joonghoon, a spokesperson for South Korea’s Unification Ministry, which oversees relations with North Korea, told reporters last week that the North may announce its COVID-19 crisis has been resolved this month.
Nam, the South Korean professor, said the outbreak appears to have eased in Pyongyang, North Korea’s capital, but will likely continue in rural areas, where some people with symptoms are venturing out of doors because they rely on market activities for a living and have no access to public rations.
“I think North Korea will declare a victory over the pandemic a bit later. It would lose face if it proclaimed victory too soon and new patients cropped up afterwards,” Nam said.
Kang, the defector, said that North Korean residents in Hyesan abide by the government’s anti-pandemic orders and that few fever patients go outside during quarantine periods.
Because North Korea believes that the pandemic, U.N. sanctions and other economic difficulties will continue, there’s little chance it will lift major restrictions soon, said Lim Eul-chul, a professor at Kyungnam University’s Institute for Far Eastern Studies in Seoul.
“The United States and other countries with advanced health care and medical systems haven’t declared an end to COVID-19. So North Korea will also find it much more difficult to do so,” Lim said.
The global vaccine alliance GAVI said earlier this month that it understands that North Korea has accepted an offer of vaccines from China. But North Korea has ignored South Korean and U.S. offers of medical support.
Despite its COVID-19 outbreak, North Korea has continued test-firing missiles this year. But it hasn’t yet carried out a widely expected nuclear test, possibly because of worries about a potential backlash from people still struggling with the virus.
North Korea may officially declare victory over the virus when its daily fever cases and the pandemic situation in neighboring China ease significantly, said Ahn Kyung-su, head of DPRKHEALTH.ORG, a website focusing on health issues in North Korea.
But he said such a declaration doesn’t mean much because North Korea likely only acknowledged the outbreak last month because it had determined that it was manageable.
“According to North Korea, it defeats everything. It doesn’t acknowledge things that it can’t overcome. It always wins absolutely, no matter whether it faces military, economic or pandemic difficulties,” Ahn said.
Little Fletcher Pack woke up Monday morning and asked: “Is today vaccine day?”
For the 3-year-old from Lexington, South Carolina, the answer was yes.
The nation’s infants, toddlers and preschoolers are finally getting their chance at COVID-19 vaccination as the U.S. rolls out shots for tots this week. Shipments arrived in some locations over the weekend and some spots, including a Walgreens in South Carolina and another in New York City, opened up appointments for Monday.
Fletcher’s mother said that once her son is fully vaccinated, he can finally go bowling and visit the nearby children’s museum.
“He’s never really played with another kid inside before,” McKenzie Pack said. “This will be a really big change for our family.”
She began seeking an appointment last week as U.S. regulators took steps to OK the vaccines for kids 6 months to 5 years old.
“It’s just relief,” said Pack. “With this vaccine, that’ll be his best shot at going back to normal and having a normal childhood.”
“This is certainly an exciting moment in what has become a very long campaign to vaccinate people against COVID-19,”said Dr. Matthew Harris, an emergency room pediatrician at Northwell Cohen Children’s Medical Center in New York.
Many parents have been anxiously awaiting the rollout, and Harris said shots for his own 9-month-old are a “matter of when, not if.’’
Roughly 18 million youngsters under 5 are eligible.
“It’s just a huge step toward normalcy,’’ said Dr. Debra Langlois, pediatrician at University of Michigan Health C.S. Mott Children’s Hospital.
“We’re two-plus years into this pandemic and there’s things that my 4-year-old has never been able to do,’’ Langlois said.
The family skipped a trip to Disneyland and a popular Michigan vacation island because the ferry ride to Mackinac Island would mean mingling with unmasked passengers.
President Joe Biden, public health authorities and pediatricians hailed the moment. But they also acknowledged that getting some parents on board may be a challenge given disappointing vaccination rates — about 30% — in school-age kids.
The American Academy of Pediatrics and American Medical Association were among physician groups that encouraged doctors and families to get young children vaccinated.
The CDC advises vaccination even for those who already had COVID-19 to protect against reinfection, and says it is OK to get other vaccines at the same time. For the littlest kids, there’s Pfizer’s three-shot series or Moderna’s two shots.
In New York’s largely Latino neighborhood of Washington Heights, Dr. Juan Tapia Mendoza’s clinic has ordered 300 doses of the tot-sized vaccines. He said he needs educational materials that directly address misinformation spreading among parents.
His approach will be to tell parents “if they were my kids, I would vaccinate them.”
“Because the virus is still around. A lot of people are still dying because of coronavirus Kids do get infected and some kids get severely affected and nobody wants to see a child very sick.”
Some hospitals planned vaccination events later this week. Chicago is among locations that offer COVID-19 shots in people’s homes and planned to open registration this week for home appointments for infants and other young children, said Maribel Chavez-Torres, a deputy commission for the city’s Department of Public Health.
Dr. Pam Zeitland, director of pediatric medicine at National Jewish Health in Denver, recommends parents get their kids vaccinated as soon as possible.
“Some parents are afraid that the younger the child, the more vulnerable they might be to vaccine side effects,’’ Zeitland said, but that’s not what Pfizer and Moderna studies found. Side effects were similar to what is seen with other childhood vaccines — fever, irritability and fatigue.
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AP Medical Writer Carla K. Johnson contributed.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
U.S. health advisers on Saturday recommended COVID-19 vaccines for infants, toddlers and preschoolers — the last group without the shots.
The advisers to the Centers for Disease Control and Prevention unanimously decided that coronavirus vaccines should be opened to children as young as 6 months. The final signoff was expected later in the day from CDC Director Dr. Rochelle Walensky.
While the Food and Drug Administration OKs vaccines, it’s the CDC that decides who should get them.
The government has been gearing up for the start of the shots early next week, with millions of doses ordered for distribution to doctors, hospitals and community health clinics around the country.
Roughly 18 million kids will be eligible, but it remains to be seen how many will ultimately get the vaccines. Less than a third of children ages 5 to 11 have done so since vaccination opened up to them last November.
Pfizer’s vaccine is for 6 months through 4 years. The dose is one-tenth of the adult dose, and three shots are needed. The first two are given three weeks apart, and the last at least two months later.
Moderna’s is two shots, each a quarter of its adult dose, given about four weeks apart for kids 6 months through 5. The FDA also approved a third dose, at least a month after the second shot, for kids with immune conditions that make them more vulnerable to serious illness.
HOW WELL DO THEY WORK?
In studies, vaccinated youngsters developed levels of virus-fighting antibodies as strong as young adults, suggesting that the kid-size doses protect against coronavirus infections.
However, exactly how well they work is hard to pin down, especially when it comes to the Pfizer vaccine.
Two doses of Moderna appeared to be only about 40% effective at preventing milder infections at a time when the omicron variant was causing most COVID-19 illnesses. Pfizer presented study information suggesting the company saw 80% with its three shots. But the Pfizer data was so limited — and based on such a small number of cases — that experts and federal officials say they don’t feel there is a reliable estimate yet.
SHOULD MY LITTLE ONE BE VACCINATED?
Yes, according to the CDC’s advisers. While COVID-19 has been the most dangerous for older adults, younger people, including children, can also get very sick.
Hospitalizations surged during the omicron wave. Since the start of the pandemic, about 480 children under age 5 are counted among the nation’s more than 1 million COVID-19 deaths, federal data show.
“It is worth vaccinating, even though the number of deaths are relatively rare, because these deaths are preventable through vaccination,” said Dr. Matthew Daley, a Kaiser Permanente Colorado researcher who sits on the advisory committee.
WHICH VACCINE SHOULD MY CHILD GET?
Either one, says Dr. Peter Marks, the FDA’s vaccine chief.
“Whatever vaccine your health care provider, pediatrician has, that’s what I would give my child,’’ Marks said Friday.
The doses haven’t been tested against each other, so experts say there’s no way to tell if one is better.
One consideration: It takes roughly three months to complete the Pfizer three-shot series, but just one month for Moderna’s two shots. So families eager to get children protected quickly might want Moderna.
WHO’S GIVING THE SHOTS?
Pediatricians, other primary care physicians and children’s hospitals are planning to provide the vaccines. Limited drugstores will offer them for at least some of the under-5 group.
U.S. officials expect most shots to take place at pediatricians’ offices. Many parents may be more comfortable getting the vaccine for their kids at their regular doctor, White House COVID-19 coordinator Dr. Ashish Jha said. He predicted the pace of vaccination to be far slower than it was for older populations.
“We’re going see vaccinations ramp up over weeks and even potentially over a couple of months,” Jha said.
CAN CHILDREN GET OTHER VACCINES AT THE SAME TIME?
It’s common for little kids to get more than one vaccine during a doctor’s visit.
In studies of the Moderna and Pfizer shots in infants and toddlers, other vaccinations were not given at the same time so there is no data on potential side effects when that happens.
But problems have not been identified in older children or adults when COVID-19 shots and other vaccinations were given together, and the CDC is advising that it’s safe for younger children as well.
WHAT IF MY CHILD RECENTLY HAD COVID-19?
About three-quarters of children of all ages are estimated to have been infected at some point. For older ages, the CDC has recommended vaccination anyway to lower the chances of reinfection.
Experts have noted re-infections among previously infected people and say the highest levels of protection occur in those who were both vaccinated and previously infected.
The CDC has said people may consider waiting about three months after an infection to be vaccinated.
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AP reporter Zeke Miller in Washington contributed.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
