Duke-NUS Centre for Outbreak Preparedness statement on the Public Health Emergency of International Concern by the World Health Organization for Monkeypox


18 August 2022


On the 23rd of July 2022, the World Health Organization (WHO) declared that the current Monkeypox outbreak constitutes a Public Health Emergency of International Concern (PHEIC). With cases crossing the 30,000 mark (and 12 deaths) as of 11th Aug 2022, the Duke-NUS Centre for Outbreak Preparedness welcome and fully support this decision by the WHO.

The Monkeypox outbreak has now been detected in close to 90 countries where it is not been previously seen. Therefore, it is timely for the PHEIC to be declared to increase efforts to stop the spread and risks to public health.


Call for a globally coordinated response

A global health emergency requires global cooperation. This includes a multi-country, multi-sectoral approach to strengthening health systems to respond in a coordinated and effective manner in stopping human-to-human transmission of Monkeypox.

Disease detection and surveillance capacity should be established within a national infectious disease surveillance system with access to testing and treatment. Monkeypox cases need to be notified immediately to WHO through established channels under the provision of the International Health Regulations (2005).

A global standard of practice in case definitions for suspected, probable, and confirmed cases of Monkeypox should be adopted. Data sharing between countries is encouraged within an acceptable framework to learn best practices and to strengthen cross-country healthcare systems and capacity.


Ensure equitable access to diagnostics, therapeutics, and vaccines

The Covid-19 pandemic is an example of how global health systems failed to ensure equitable access to affordable diagnostics, therapeutics, and vaccines. Monkeypox, endemic in several countries for many years prior to the current outbreak highlights the need to share and distribute resources and expertise equitably. Re-aligning priorities to protect vulnerable communities in low and middle-income countries is crucial in enhancing regional and global health security.


Prepare manufacturing capacity and enhance supply chain resilience

The PHEIC declaration will undoubtedly put a spotlight on manufacturing capacity for diagnostics, therapeutics, and vaccines for Monkeypox. Currently, only two vaccines are licensed for use to protect against monkeypox and one antiviral for treatment, and these are only available in very short supply. Therefore, countries with manufacturing capacity need to work with biotechnology and pharmaceutical companies to scale up manufacturing capacity when needed. Protecting the supply chain of equipment, reagents, consumables, and vaccine-related materials is crucial so countries can access these healthcare products without delay.

A harmonised approach to regulatory processes in approving diagnostics, therapeutics and vaccines is also needed to ensure the licensure of novel vaccines and therapeutics as well as expansion of current vaccines in more countries. It is imperative that there is no delay in distributing these life-saving tools while maintaining the highest standard of quality.


Engaging communities with accurate information

Covid-19 has shown us misinformation and discrimination are prevalent in a global health crisis. There is a need to intensify awareness about Monkeypox transmission methods, signs and symptoms, treatment and how it affects certain communities. Focus on risk communication by engaging the community to promote prevention methods and risk-reducing behaviour.

Response actions must include community interventions in changing perception, correcting misinformation, and encouraging transparency in coming forward for testing and treatment.



The Monkeypox outbreak is a new test case on whether we can pivot learning from COVID-19 and apply it to other outbreak risks and pandemics. There are many opportunities to correct the failures of global health systems and the declaration of PHEIC is the perfect catalyst to do so.

The Duke-NUS Centre for Outbreak Preparedness will continue its work to enhance regional health security through capacity building within infectious diseases surveillance systems, enhancing the development and access to novel diagnostics, therapeutics, and vaccines to address outbreak threats, strengthening health system readiness and foster an enabling environment for these processes to thrive.