Third meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox

The WHO Director-General transmits the report of the third meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypox, held on Thursday, 20 October 2022, from 12:00 to 17:00 CEST.

The Emergency Committee acknowledged that some progress has been made in the global response to the multi-country outbreak of monkeypox since the last meeting, including the emerging information on the effectiveness of behavioural interventions and vaccines. The Committee held the consensus view that the event continues to meet the IHR criteria for a Public Health Emergency of International Concern (PHEIC) and highlights the primary reasons for ongoing concern. These include ongoing transmission in some regions, continuing preparedness and response inequity within and between WHO Member States, an emerging potential for greater health impact in vulnerable populations, continuing risk of stigma and discrimination, weak health systems in some developing countries leading to under-reporting, ongoing lack of equitable access to diagnostics, antiviral and vaccines, and research gaps needing to be addressed.

The WHO Director-General expresses his gratitude to the Chair, Members, and Advisors for their advice and concurs with this advice that the event continues to constitute a PHEIC for the reasons detailed in the proceedings of the meeting below. The Director-General issues revised Temporary Recommendations in relation to this PHEIC, which are presented at the end of this document.

Proceedings of the third meeting of the IHR Emergency Committee

The third meeting of the IHR Emergency Committee on the multi-country outbreak of monkeypox was convened by videoconference, with the Chair and Vice-Chair being present in person on the premises of WHO headquarters, Geneva, Switzerland. Members and Advisors joined by videoconference. Eleven of the 15 Members and 6 of the 9 Advisors to the Committee participated in the meeting. The WHO Director-General, in his opening remarks, welcomed the Committee, noting a promising decline in cases globally, although progress in the regions of the Americas and Africa is less certain, where cases are rising in some countries, and underreporting is likely in others.

The Representative of the Office of Legal Counsel reminded the Members and Advisors of their roles and responsibilities and 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 also reminded Members and Advisors of their roles and responsibilities, including their duty of confidentiality as to the meeting discussions and the work of the Committee; as well as 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 direct conflict of interest. Each Member and Advisor who was present was surveyed. No conflicts of interest were noted.

It was noted that one Member has withdrawn from the Committee on account of other commitments 

The meeting was handed over to the Chair of the Emergency Committee, Dr Jean-Marie Okwo-Bele, who introduced the objectives of the meeting: to provide views to the WHO Director-General as to whether the multi-country outbreak of monkeypox continues to constitute a PHEIC, and, if so, to review the proposed temporary recommendations to States Parties. 


Representatives of Brazil, Ghana, and Sudan updated the Committee on the epidemiological situation in their countries and their current response efforts.

The WHO Secretariat updated the Committee on the global epidemiological situation as well as on the rapidly evolving knowledge in understanding the clinical manifestation and evolution of the disease. Details can be found in the weekly epidemiological update and in the 8th External situation report; WHO updates the information regularly through the external situation reports. All data are also available and case counts are updated daily at this link: 2022 Monkeypox Outbreak: Global Trends (

The Secretariat noted that, since the determination of the PHEIC on 23 July 2022, many more countries have promptly responded to the outbreak with a range of public health interventions and cases are declining globally. Nonetheless, the picture is mixed and, overall, the risk assessment conducted by the WHO Secretariat concludes that as of 18 October 2022 the public health risk remains moderate globally; at regional level, risk was assessed as high in the WHO region of the Americas, declining from high to moderate in the European region, remaining moderate for the WHO Regions of Africa, Eastern Mediterranean, and South-East Asia, and remaining low in the Western Pacific Region.

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