Just as the world began recovering from the COVID-19 outbreak, another virus now threatens global public health once again. There are currently over 23,000 cases of monkeypox across 80 countries. While central and west Africa have reported monkeypox infections for several decades, the virus has now spread to countries that have not historically reported any cases. In fact, 73 out of the 80 countries reported infections for the first time.
While the unprecedented spread of monkeypox is of great concern, the lack of a coordinated and expedited global response also demonstrates just how little the international community has learned from the COVID-19 pandemic.
Admittedly, several steps have been taken to curtail the outbreak. Most notably, in late July, the World Health Organisation (WHO) declared monkeypox as a Public Health Emergency of International Concern (PHEIC) and called on countries to work toward a coordinated response. In fact, several of its personal and institutional protocol recommendations urge countries to use their COVID-19 resources, such as personal protective equipment and political and medical institutional memory, to deal with the virus.
Moreover, the United States (US) and the European Union (EU) expedited the approval of smallpox jabs for monkeypox and began vaccine drives just weeks after the virus was detected.
Yet, WHO chief Tedros Adhanom Ghebreyesus himself admitted that the monkeypox outbreak had once again highlighted the need to reform international mechanisms to make the coordinated responses “more effective” and re-emphasised the need for a new international public health treaty.
Access to life-saving prevention tools, testing & treatment – whether for #HIV, #COVID19 or #monkeypox – too often relies on chance: your birthplace, skin colour, gender, how much you earn. Health shouldn't be a privilege, it's a human right. #AIDS2022 pic.twitter.com/hjpy3OHuXi
— Tedros Adhanom Ghebreyesus (@DrTedros) August 1, 2022
However, these reforms need to come from within the WHO itself, which has failed to learn its lessons from delaying the recognition of COVID-19 as a global threat. It only recognised COVID-19 as a PHEIC towards the end of January 2020, once the virus had already spread to 19 countries and infected 10,000 people. Moreover, Tedros only declared a pandemic in March 2020, by which point the coronavirus had already infected over 118,000 people and killed 4,291 across 114 countries.
These concerns once again came to the fore during the early months of the monkeypox outbreak. In May, the Emergency Committee of the International Health Regulations decided that the monkeypox outbreak did not qualify as a PHEIC, despite 47 countries having already reported 3,040 cases. Concerningly, Tedros was forced to declare monkeypox as a PHEIC two months later without the endorsement of the Committee.
According to Adesola Yinka-Ogunleye, an epidemiologist at the Nigeria Centre for Disease Control in Abuja, African epidemiologists had issued several warnings about the virus and its ability to spread outside the continent. However, the WHO ignored the warnings until the virus reached North America and Europe.
🚨 WHO's own expert panel voted 9–6 AGAINST emergency declaration for monkeypox.
— Dr. Eli David (@DrEliDavid) July 23, 2022
WHO chief overruled the panel and decided to declare emergency 🤡 pic.twitter.com/tcm2U0eiTy
Moreover, despite the declaration, countries have failed to expedite or coordinate surveillance. Furthermore, despite the COVID-19 pandemic underscoring the importance of testing and tracing, the testing capacities for laboratories across the globe remain low. For instance, the United States’ (US) Centre for Disease Control only expanded its testing capabilities to four large commercial laboratories by late June, despite evidence of the virus spreading since early May.
In addition, US health authorities were heavily restrictive in their testing, refusing to test those with atypical manifestations of other diseases like genital herpes, whose symptoms can be similar to monkeypox. From mid-May to the end of June, merely 2,000 tests were conducted, despite experts recommending at least 15,000 tests per week.
Vaccine programmes, too, have been severely lacking, despite monkeypox not requiring mass inoculation drives like COVID-19. Given that most monkeypox patients have been men who have had homosexual relations, vaccine drives can be limited to specific target groups. At the same time, there isn’t a race to develop a vaccine as there was with COVID-19, given that the smallpox vaccine prevents severe manifestations in 85% of the cases.
Despite these favourable conditions, however, countries have failed to secure sufficient doses. By mid-May, despite the virus having already spread to 47 countries, the US had merely 2,400 doses. Furthermore, only one company, Denmark’s Bavarian Nordic, develops the vaccine, making it highly inaccessible.
Although the US announced that it will release 786,000 smallpox vaccines this week, equitable access across the globe remains a huge concern, drawing concerning parallels with the vaccine hoarding by richer nations seen during the COVID-19 pandemic.
As of July 29, only 300,000 jabs were available, across 16 countries, most of which are in North America and Europe. In Africa, where the virus is believed to have originated and has which has reported cases for years now, only the Democratic Republic of Congo and Nigeria have stocks of the jabs.
Wait, so experts have been raising the alarm about monkeypox for years due to outbreaks in central and west Africa and their warnings went unheeded, but now Europeans and USians are being infected so finally resources are being mobilized and funding redirected?
— uché blackstock, md (@uche_blackstock) July 23, 2022
Got it!
African nations have requested to be prioritised for smallpox vaccines, given that the continent has reported over 2,100 cases since the beginning of 2022. Moreover, public health officials reported a “more dangerous version of the disease” in Africa. However, countries like the US, EU, and Canada have been purchasing the vaccines in large quantities, effectively stripping African countries of access.
The WHO has anticipated this inequality and vowed to set up a mechanism that ensures “fair access,” particularly for low- and middle-income countries. However, there are no details on how it will address the shortcomings of the COVAX programme introduced during the COVID-19 pandemic, which repeatedly missed its targets.
It's unconscionable that Africa doesn't have a single dose of monkeypox vaccine, despite being the only continent with deaths from the virus.
— Dr Alexandra Phelan (@alexandraphelan) July 28, 2022
Charity not only fails but is paternalistic.
Independent manufacturing capacity (not just for COVID or monkeypox) is health justice.
At the same time, the COVID-19 pandemic is still ongoing, meaning that a large portion of testing, vaccine, and various other medical resources are already spoken for. Monkeypox could also fall prey to vaccine scepticism, anti-masking ideologies, and general pandemic fatigue that impeded the public health response to the COVID-19 pandemic, wherein the virus is allowed to spread unabated.
Moreover, even those who believe in the efficacy of vaccines and personal protective measures have downplayed the risk of a monkeypox outbreak, as evidenced by the WHO’s Emergency Committee’s refusal to label the virus as a PHEIC.
However, as WHO chief Tedros has warned, information on monkeypox remains limited at this stage. Moreover, the longer the international community takes to act on the virus, the larger the possibility of it mutating becomes. COVID-19 was initially only thought to be dangerous to senior citizens and those with pre-existing conditions, but the Delta and Omicron waves soon proved otherwise. If countries take the risk of assuming that monkeypox can and will only affect a small subset of their populations, they could be risking invoking yet another deadly pandemic.