Monkeypox decision backed by experts as spread continues

As the WHO declared the multi-country outbreak of monkeypox constitutes a Public Health Emergency of International Concern (PHEIC), leading scientists have said the time for action to combat the spread has arrived.

They expressed fears that unless there is a higher awareness of the threat and the disease itself the world will be left after two global epidemics, and while there are treatments and a vaccine, at present the most effective strategy has yet to be identified.

“The ongoing spread of MPX, facilitated by hitherto unappreciated modes of transmission and scenarios that prevent easy identification of contacts, has taken the global public health community by surprise,” added Dr Hugh Adler, of the Department of Clinical Sciences, Liverpool School of Tropical Medicine. “This declaration does not mean that MPX is a severe illness or causing high rates of mortality, nor does it mean that MPX meets the criteria for a pandemic.  It does mean that this outbreak is extraordinary/unprecedented, that it is affecting multiple countries, and that a coordinated international response is required.”

He added: “The rate of spread of monkeypox has not slowed, and public health strategies have not shown a high rate of success.  We have more data showing that MPX is presenting in atypical ways, that contact tracing is a massive challenge given the unique circumstances of this outbreak, and that countries are struggling to access vaccine supplies.”

On the decision to declare the outbreak a PHEIC, Adler added: “I think it is a positive development if it succeeds in its intended aim – to raise the political priority of this outbreak, step up the production and supply of vaccines and ensure that vaccines are made available where they are most needed. We have seen how countries can get embroiled in unseemly squabbles over vaccine access, and a key challenge for the WHO will be whether it can moderate such disputes and ensure equitable access. The WHO also noted that MPX continues to circulate in West and Central Africa, with a far higher mortality rate reported in Nigeria than in high-income countries, and these nations need just as much support.”

Professor Piero Olliaro, professor of Infectious Diseases of Poverty, University of Oxford, said the scientific community found itself in a paradoxical situation with monkeypox.

“On the one hand our knowledge of the clinical presentation and outcomes of monkeypox in the Western world is improving, and we even have potentially one or more treatments and a vaccine, on the other hand we still have little evidence to support which intervention should be used and how to break the chains of transmission and how to effectively manage cases,” he explained. “This because evidence of clinical benefits and public health gains of using these drugs and vaccine has yet to be produced – tecovirimat and vaccine are registered without clinical data.

“Between these uncertainties and the high prices reportedly charged, drug and vaccine supplies are very limited, even in the countries where products are registered.

“So, the hope is that, whether though a PHEIC status or other means, the sense of priority and urgency is raised for governments to not only negotiate procurement with manufacturers, but, importantly, invest into the necessary research to answer those questions and gather evidence of patient-centred and/or public health gains, and cost-effectiveness of using these interventions (drug, vaccine, etc.).”

Dr Boghuma Kabisen Titanji, assistant professor of Medicine, Emory University, Atlanta, said: “I hope that this will raise the international priority level on monkeypox and galvanise a more coordinated global response which has sadly been lacking so far. It is also an opportunity to get things right on global health equity and access to resources such as testing, vaccination, antiviral medications etc. which are areas in which historically we have seen many failures, resulting in countries with limited resources being left behind.

“Having another zoonotic virus infection firmly establish itself in the human population is not something we can allow and must do everything within our power to prevent this from happening. The PHEIC is just the first step and there is a lot of work that needs to be done here onwards, it is nonetheless and important move which hopefully corrects the course of the response to this emerging pandemic.”

Professor Jimmy Whitworth, emeritus professor, London School of Hygiene and Tropical Medicine, added: “This outbreak is concerning for public health practitioners around the world as it has proved very challenging to prevent onward transmission of infection, but it is not a situation that should unduly worry the general public. This is an infection that is transmitted by close contact – touching skin, coughing and sneezing, sharing of utensils, bedding and so on. The vast majority of cases have been in gay, bisexual or other men who have sex with men who have had multiple recent sexual partners. Most people, whatever their sexual orientation, do not have close contact of this sort with many people and so the infection is unlikely to spread easily.

“It is to be hoped that the increased attention to this disease leads to more focus on control within  Africa, the natural home of this virus, where the number of cases has been increasing for the past 20 years.”