Members of a World Health Organization (WHO) expert group are split over whether the monkeypox outbreak represents a global health emergency, but the agency's director-general may still issue the maximum alert on Saturday, two sources close to the decision told Reuters.
The committee, which met on Thursday, provides advice to WHO Director-General Tedros Adhanom Ghebreyesus, who is responsible for making the final decision over whether to declare a global health emergency.
In the past, Tedros has always gone with the committee's recommendation, but the sources, who spoke on condition of anonymity, said he was seriously considering declaring the agency's highest level of alert despite the lack of a majority opinion due to his concern about the urgency of the situation.
The WHO is due to hold a news conference at 1300 GMT on Saturday to announce his ultimate decision.
The label - a "public health emergency of international concern" - currently only applies to the coronavirus pandemic and ongoing efforts to eradicate polio.
In recent weeks, pressure has been increasing from scientists and public health experts for the WHO and national governments to take more action on monkeypox. There have now been more than 14,000 cases reported, and five deaths, from 71 WHO member states.
When the committee first met at the end of June, there were only about 3,000 cases.
The WHO alert serves to raise the alarm and can also unlock funding and global efforts to collaborate on sharing vaccines and treatments.
There are already effective treatments and vaccines for monkeypox, but they are in short supply. The WHO has also already been providing advice and updates since the outbreak began in early May.
At the first meeting of the expert committee, the group said it would reconsider its position on the emergency declaration if the outbreak escalated.
In Europe and the United States, cases have almost entirely been reported among men who have sex with men, and the committee also said it would reconsider if other groups began to report cases, particularly children or others who have been more vulnerable to the virus in past outbreaks in endemic countries.
On Friday, the United States identified its first two monkeypox cases in children.
Any changes to the virus itself, which spreads through close contact and causes lesions and flu-like symptoms, could also spark a rethink, the committee has said.
The group is now split between those who think an emergency declaration would accelerate efforts to contain the disease, and those who do not think it meets the criteria because it has not yet spread to new groups of people or had a high fatality rate, the sources said.
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