The World Health Organization (WHO) will decide on Thursday whether to declare monkeypox a global health emergency, stirring criticism from leading African scientists who say it has been a crisis in their region for years.
The deliberations and scrutiny of the WHO's response to the outbreak follows concerns over how the UN agency and governments worldwide handled Covid-19 in early 2020.
Monkeypox does not spread nearly as easily as Covid and there are vaccines and treatments available unlike for the coronavirus when it emerged. But it has still raised alarm.
The case count from the current outbreak outside of Africa has topped 3,000 in more than 40 countries, according to a Reuters tally - largely among men who have sex with men - since it was first reported in May. There have been no reports of deaths.
The viral disease that causes flu-like symptoms and skin lesions is endemic in parts of Africa. The continent has registered just over 1,500 suspected cases since the start of 2022, of which 66 have been fatal, according to official data.
"When a disease affects developing countries, it is not an emergency. It only becomes an emergency when developed countries are affected," said Professor Emmanuel Nakoune, acting director of the Institut Pasteur in Bangui, the Central African Republic, who is running a trial of a monkeypox treatment.
However, Nakounde said if the WHO declares a "public health emergency of international concern", - its highest level of alarm - it would still be an important step.
"If there is the political will to share equitably the means of response between developed and developing countries... each country will be able to benefit," he said.
The WHO has said it is working on a mechanism for sharing treatments and vaccines.
The emergency committee meeting on Thursday includes experts from the most affected regions, who have also consulted with scientists including Nakounde. They will make a recommendation to WHO Director-General Tedros Adhanom Ghebreyesus, who makes the ultimate decision over whether to call the emergency.
The step mainly functions to sound the alarm, and can prompt further guidance from the organization, as well as focus attention among member states.
Most experts agree monkeypox technically meets the criteria for the WHO definition of an emergency. It is a sudden and unusual event spreading internationally, and requires cross-country co-operation.
But the WHO is in a precarious position after Covid, said Clare Wenham, a global health assistant professor at the London School of Economics.
If the WHO declares an emergency and countries do not act, it could undermine the agency's role in controlling global disease, she said.
"They're damned if they do, and damned if they don't," she added.