Managing Risk in the Face of Uncertainty: The Case of Monkeypox – The Conversation

We find ourselves in a world that is increasingly exposed to risks and dangers. Given this, the scientific community is not always certain of how to act. The last of these risks or dangers is the so-called monkeypox. Let us analyze how the risks have been managed at the international level in a situation that, as will be seen, does not have a consensus in health expert knowledge. What is meant by risks and hazards? Risk is understood as the undesired effects that have their origin in human action. As the sociologist Niklas Luhmann (1927-1998) pointed out, risks have their origin in human decisions and, therefore, are identifiable. In this they differ from hazards, which have their origin in external and environmental causes. In the case of monkeypox, we are faced with a danger that, due to human action, can become a risk. For this reason, the WHO declared it a “public health emergency of international importance” (PHEIC). However, what is meant by a public health emergency of international concern? Under what procedure is the risk threshold from which immediate action is necessary by all countries decided? How is a public health emergency of international concern declared? An extraordinary event is considered to be one that, in accordance with the 2005 International Health Regulations: Constitutes a risk to the public health of other states due to the international spread of a disease. It could require a coordinated international response. On the other hand, regarding the procedure, the aforementioned regulation provides for the existence of an Emergency Committee. This is made up of experts chosen by the Director General of the WHO and will advise you on the suitability of declaring an event as a PHEIC. The criteria under which the health risk threshold is decided (art. 12) are as follows: The information provided by the State party. The opinion of the Emergency Committee. The scientific principles, as well as the available scientific evidence. An assessment of the risk to human health, the international spread of the disease and the barriers to international traffic. According to the declaration of the WHO director-general of July 23, 2022, all the criteria for declaring monkeypox as a public health emergency of international concern are met. However, the management of this danger deserves some comments. Are the necessary elements given to declare monkeypox as PHEIC? 1. All members and advisors of the Emergency Committee are related to the scientific field. In these cases, without undermining the importance of scientific doxa, the importance of the entry of experts from other fields could be sustained. Although it has a great scientific aspect, risk management implies an interdisciplinary response with other social actors, such as economics, law and ethics. Scientific technique is essential, but it can say nothing, at least nothing scientific, about other social spheres that are at stake during risk management. Among the recommendations mentioned in the monkeypox emergency declaration is the “non-stigmatization of the group” on which the transmission is focused. This is related to areas outside scientific-experimental knowledge. In this sense, Leon Gordis (1934-2015), probably one of the most respected epidemiologists of recent decades, author of a basic manual of this discipline, stated: “Epidemiology, together with other disciplines, can provide much of the data scientists that are relevant to questions of risk and prevention. However, the final decision to initiate a prevention program will be primarily determined by political and economic considerations, as well as societal values.” 2. The director general of the WHO, Tedros Adhanom, justifies the concurrence of all the criteria to declare the situation as PHEIC. However, at first glance, the justification for the second criterion, which is the opinion of the Emergency Committee, is insufficient. From the CEO’s statement, it can be deduced that the Emergency Committee did not reach a consensus, and this forced him to choose his own criteria. From the wording of the International Health Regulations it is not deduced that the consensus of the committee is necessary to declare a health emergency as international and it is stated that “the opinion of the Emergency Committee” will be taken into account. Now, although it is true that this opinion of the committee is not binding on the director, it must also be considered that, in reality, the majority of the committee was against declaring monkeypox an international health emergency. In this way, the threshold of risk to be assumed and, therefore, the declaration of the international health emergency was determined solely by the director general of the WHO. This reality can cause controversy. What exactly were the criteria that were decisive in taking this extreme epidemiological measure? Should metasanitary reasons be considered when setting the admissible risk threshold? In conclusion, from the analysis of the information presented in this article, three questions must be carefully considered: Does it not seem that, stripped of scientific consensus, the decision has been mainly political? Regarding risk management, shouldn’t experts from other fields be allowed in? Isn’t the process by which the risk threshold is decided too inconsistent? Paradoxically, the analysis of risk management in monkeypox, far from giving us certainties, may raise new questions.