Person showing some papers to an attendant near a sign that reads “Monkeypox Prevention Tips.” Photo: Beijing News/Twitter.
By Ana Vračar and Gargeya Telakapalli – Ago 1, 2022
The World Health Organization declared the global monkeypox outbreak a Public Health Emergency of International Concern, calling upon countries to roll out a public health response and ensure access to the necessary vaccines and medicines
On July 23, the World Health Organization (WHO) declared the monkeypox outbreak a Public Health Emergency of International Concern (PHEIC). As of July 29, over 22,000 people in more than 75 countries have contracted the disease, raising concern among global public health experts and health activists, as well as the general public. Along with the distress arising from the possibility of a new pandemic, the response to the outbreak has led to criticism because of the different reactions it caused while confined to areas in West and Central Africa, and once it affected countries in the Global North.
The announcement by Tedros Adhanom Ghebreyesus, WHO director-general, came weeks after the first deliberations by an Emergency Committee on the outbreak, which found there was no ground for announcing a PHEIC. A public health emergency announcement is supposed to provide health systems and governments with enough time and advice for building up their response in case things escalate further.
According to many global health experts, including WHO’s director-general himself, the current outbreak meets the necessary criteria to declare a PHEIC according to the International Health Regulations (IHR 2005), including unusual modes of transmission and fast international spread. Yet, the virus has been present in several African countries, including the Central African Republic (CAR), the Democratic Republic of the Congo (DRC) and Nigeria – all with health systems weakened by failing economies, inadequate funding and conflict – for decades, but caused little interest or action from high-income countries.
“Monkeypox has been an ongoing health crisis in West and Central Africa for years. In Nigeria it had already spread to urban settings, DRC sounded the alarm bell long ago, but no one was there to listen. It only became a big deal after it reached the Global North,” says Gregg Gonsalves, global health activist and epidemiologist.
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A targeted public health campaign to protect affected communities
Outside of West and Central Africa, where monkeypox cases are encountered in all demographic groups, the community most affected by the spread of the virus in the West are gay and bisexual men, and other men who have sex with men. This has led to parallels being drawn with the HIV/AIDS pandemic, and some members of the WHO Emergency Committee voiced concern that a targeted public health campaign – one that would focus primarily on the communities most impacted by the outbreak – could result in stigmatization of the LGBTI+ community like in the case of the HIV/AIDS pandemic.
Since then, many activists and public health experts have warned that letting the fear of repeating mistakes drive the campaign would likely have long-term negative effects. “We have to speak out loudly against stigma and discrimination, and at the same time we must make sure that the response that is implemented does not lead to an erosion of LGBTI+ health rights: it could turn out to be too easy for governments not to carry out a campaign and say, ‘We don’t care about this because it’s not putting the general population at risk’,” points out Gonsalves.
Similar views have been expressed by other scientists and activists who are following the outbreak, and who continue to warn that gaining quick control of the spread will be crucial for determining how the situation will evolve.
We are two months into an outbreak of monkeypox across the world and I find it incredibly frustrating that we seem to be stuck on debating whether this virus is really overwhelmingly affecting MSM (and whether it is homophobic to point that out) or whether to call this an STD.
— Kai Kupferschmidt (@kakape) July 26, 2022
That the spread of monkeypox is currently predominantly among gay and bisexual men, and other men who have sex with men, in the West has been misrepresented by some early reactions as monkeypox being a sexually transmitted disease. In fact, the virus is spread through close physical contact, underlined the WHO and the United Nations as they warned against similar misinformation that can lead to stigma and discrimination.
To counter the share of inaccurate information, public health authorities and governments have to set up clear and precise communications to the public. And while the primary responsibility for this lies with the health authorities and governments, in the short term the LGBTI+ community can play a role in protecting people’s health as well. “The LGBTI+ community can help protect their members’ health by sharing the information we have, and making sure that there is a safe and instructive space to discuss what is going on,” says Gonsalves.
Increasing access to existing vaccines stockpiles
As monkeypox stays in the headlines of mainstream media, it is important to remember that this outbreak is not the same as the AIDS or COVID-19 pandemic. Gonsalves specifies: “This is a known disease. We have known about monkeypox for decades, and there already are vaccines and treatments that can be used as we try to control the spread. But the question is, who has access to those vaccines and treatments?”
The overwhelming majority of the existing smallpox vaccine doses which can also be used against monkeypox are held in the national stockpiles of high-income countries such as France, Japan, and the US – which keeps approximately 100 million doses of different smallpox vaccines in its Strategic National Stockpile. On the other hand, even as they faced periodic increases in the number of cases, countries where monkeypox is considered endemic have largely gone without. This remained the case although members of the WHO secured over 31 million doses of smallpox vaccine for the agency to use in case of emergencies.
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While smallpox vaccines remain out of reach for countries in Africa, where since the beginning of 2022 over 1,700 cases of monkeypox have been reported and at least 79 people have died, health systems in high-income countries are rolling out vaccination campaigns and ordering additional vaccine doses. The unequal effect of the disease can be sensed from the reported data alone, considering that the WHO European Region, which reported approximately the same number of cases of monkeypox in the period from January to mid-June 2022 as the Africa Center for Disease Control and Prevention did, recorded no related deaths.
Health systems in high-income countries are facing the outbreak while also experiencing problems caused by years of austerity that have left the preventive and sexual health services that are supposed to mount a quick and effective public health campaign understaffed and underfunded. It should not come as a surprise then that the vaccine rollouts taking place in the US, the UK, and other high-income countries are being criticized for faltering. Yet the situation in the Global South, where some countries do not have one single dose of the vaccine, is incomparably worse.
The priority should be to ensure equitable access to the vaccines, tests and treatments around the world, yet the recent experience of the COVID-19 pandemic has taught us that high-income countries are not likely to put that high on their agendas if they are not pressured by the people. “Right now, we need all hands on deck. We all have to raise hell with our governments and health agencies in order to make sure that there is enough money to mount an effective response, especially outside the Global North. We need equitable solutions to end this outbreak,” concludes Gonsalves.
