The global health environment is constantly in a state of flux, and it keeps on presenting policy makers, health systems, and international organizations with new challenges. In the wake of the COVID-19 pandemic, the emergence of monkeypox, which is called "mpox" for short, constitutes a fresh global health threat and highlights the rising need for adaptable legal frameworks to address public health emergencies which will be analysed in the article.

The Evolving Threat of Mpox

On July 23, 2022, because of the rising outbreak of monkeypox around the world, the WHO Director-General declared it a Public Health Emergency of International Concern (PHEIC).[1] Among several reasons, including the big fuss that had risen with the sudden rapidity in spread to non-endemic countries and related concerns to stigmatization of the affected communities, this was declared so. It was affecting people engaging in sexual intercourse, making it a focused public health intervention measure without discrimination.

Fast forward to 2024, and the WHO has once again declared mpox a global health emergency because of an escalating crisis in the Democratic Republic of Congo that has spilled over to a dozen other African nations.[2] This time around, it is a different, probably more lethal variant of the virus, Clade I, and it affects a more diversified section of the population, including children.

Legal and Policy Implications

The resurgence of mpox as a global threat raises several legal and policy considerations:

• International Health Regulations (IHR): The fact that the mechanism under IHR, PHEIC has been invoked several times underlines its great importance in global health governance. This is as important to note, but this scenario also raises the need for continuous review and reform of the IHRs so that these are further effective in responding to the variety of health threats.
• Countermeasure Fair Access: Huge disparities in access to vaccines and treatment were brought to the fore during the mpox outbreak in 2022. The strengthening of legal frameworks at country, regional, and international levels through binding international agreements on health would be very instrumental in ensuring fair sharing of access to medical countermeasures in periods of public health emergencies.
• Data Sharing and Surveillance: Much undervalued, enhanced global surveillance and sharing of data are key to the early detection and prompt response to emerging threats. The legal mechanisms should provide a balance between the need for rapid information exchange and the concerns about privacy and national sovereignty.
• Non-Discrimination and Human Rights: Public health laws and policies have to be thoughtfully designed to protect vulnerable communities without perpetuating stigma in evolving demographics within the most recent mpox outbreak.

India's Preparedness and Legal Framework

The quickly unfolding situation with mpox has given a much-needed boost to India to review and further strengthen its legal framework in the field of public health.

A new Public Health Bill must draw on experiences from recent health emergencies underlining the need for rapid response, distribution of resources in an equitable manner, and protection of most vulnerable groups.[7] It should also deal with issues of data privacy and security, apart from incorporation of state-of-the-art surveillance technologies within its structure.[8] This needs to be ensured through proper legislation of laws and policies that enable a swift procurement, production, and dissemination of vaccines and treatments during health emergency situations.[9]

The legal framework in India will have to help actively participate in global health governance reforms and deepened bilateral and regional collaborations for health security.[10]

Global Challenges and Opportunities

The resurgence of mpox speaks to a number of very moot challenges that remain within global health:

• Emergence of Zoonotic Diseases: Continued spillovers of viruses from animals to humans call for a "One Health" approach embedded in legal and policy frameworks.^[11]
   
• Health System Resilience: It is incumbent on investment in strengthening health systems in order to provide agile responses against multiple concurrent health threats.^[12]
   
• Community Engagement: All these and other effective public health interventions would require an engaged community with sufficient processes of building trust, underpinned by appropriate legal and policy mechanisms.^[13]
   
• Research and Development: The legal regime should support and encourage the fastest possible research and development of medical countermeasures against emerging threats.^[14]

Conclusion
The evolving mpox situation reminds that global health threats are, by definition, dynamic and call for adaptive legal and policy responses. As the newest challenge is addressed, there is room to strengthen global health governance, enhance the equity of access to health resources, and have more resilient health systems.

The opportunity now provides an opening for India to set a good example in reforming the legal framework relating to modern public health challenges and to make contributions toward efforts at global health security. With growing international cooperation, investment in robust health systems, and equity in access to health resources, it would become within its grasp to occupy center stage in the future of global health preparedness and response.

End Notes:

1. World Health Org., Second Meeting of the International Health Regulations (2005) (IHR) Emergency Committee Regarding the Multi-country Outbreak of Monkeypox (Jul. 23, 2022), https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox.
2. World Health Org., WHO Director-General Declares the Ongoing Monkeypox Outbreak a Public Health Emergency of International Concern (Jul. 23, 2022), https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern.
3. Lawrence O. Gostin et al., The Legal Determinants of Health: Harnessing the Power of Law for Global Health and Sustainable Development, 393 Lancet 1857, 1857-1910 (2019).
4. World Health Org., Equity (accessed Aug. 21, 2024), https://www.who.int/health-topics/health-equity.
5. World Health Org., Surveillance, Health Information, and Digital Health (accessed Aug. 21, 2024), https://www.who.int/health-topics/digital-health.
6. World Health Org., Health and Human Rights (accessed Aug. 21, 2024), https://www.who.int/health-topics/human-rights.
7. Press Trust of India, Govt Working on National Public Health Act to Keep People Safe from Epidemics, Bus. Standard (Oct. 5, 2020), https://www.business-standard.com/article/current-affairs/govt-working-on-national-public-health-act-to-keep-people-safe-from-epidemics-120100501575_1.html.
8. Ministry of Health & Family Welfare, Gov't of India, National Health Policy 2017 (2017).
9. Indian Council of Med. Rsch., ICMR's Efforts in Tackling COVID-19 (2020), https://www.icmr.gov.in/pdf/covid/strategy/ICMR_COVID19_Strategy_Document_2ndApril2020.pdf.
10. Ministry of External Affairs, Gov't of India, India's Vaccine Maitri Initiative (accessed Apr. 24, 2024), https://www.mea.gov.in/vaccine-supply.htm.
11. World Health Org., One Health (accessed Aug. 23, 2024), https://www.who.int/health-topics/one-health.
12. World Health Org., Health Systems Resilience (accessed Aug. 23, 2024), https://www.who.int/health-topics/health-systems-resilience.
13. World Health Org., Community Engagement (accessed Aug. 23, 2024), https://www.who.int/health-topics/community-engagement.
14. World Health Org., Research and Development (accessed Apr. 23, 2024), https://www.who.int/health-topics/research-and-development.