Of International Concern

In late July, the World Health Organisation declared monkeypox a public health emergency of international concern. Since May, there have been more than 22,000 confirmed cases in nearly eighty countries around the world, of which more than 13,000 have been in Europe. The countries with the highest numbers of confirmed cases are Spain, the US, Germany and the UK. Last week Spain reported two deaths linked to monkeypox. Although the virus can spread to anyone, 98 per cent of confirmed cases are men who have sex with men (MSM), strongly suggesting that sexual contact is the primary mode of transmission of these new infections.

Before this spring, most monkeypox cases were found in West and Central Africa (two different variants of the virus), usually transmitted from rodents. There is occasional human-to-human spread, through close skin-to-skin contact or sharing bedding, towels and clothing, but the transmission chains tend to be short. About 8 per cent of infections require hospitalisation, and it can sometimes lead to life-threatening complications such as encephalitis. The mortality rate ranges from 1 to 10 per cent in the Congo basin, where the more virulent strain is endemic, with most deaths occurring among children and people who are HIV positive. The virus now spreading around the world is the less deadly variant endemic to West Africa.

In May, UNAIDS ‘expressed concern that some public reporting and commentary on monkeypox has used language and imagery, particularly portrayals of LGBTI and African people, that reinforce homophobic and racist stereotypes and exacerbate stigma’. A group of scientists from Africa, Europe and the US argued that ‘continued reference to, and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatising. The most obvious manifestation of this is the use of photos of African patients to depict the pox lesions in mainstream media in the global north.’

It is not homophobic however to argue that MSM should be prioritised for testing and vaccination. In New York City and San Francisco, community leaders and LGBTQ+ advocates have protested against the sluggish response to monkeypox by health departments. As with Covid-19 and HIV, marginalised groups have argued that the official response highlights who is neglected and which diseases get money spent on them.

The failure to contain monkeypox has worsened the conditions for the outbreak. Sharmila Shetty is a vaccines adviser for Médecins Sans Frontières. ‘The longer monkeypox circulates,’ she has said, ‘the greater chances it could get into new animal reservoirs or spread to the general human population.’ Vaccinating high-risk people and treating those who are exposed to the disease is not only the right thing to do in and of itself but also the best way to protect everyone.

The smallpox vaccine is effective against monkeypox before exposure and can also help prevent disease or make it less severe after exposure. The Danish company Bavarian Nordic already has the capacity to make thirty million doses a year and is looking to expand that. But as with Covid-19 (and other diseases), it’s a question of distribution as well as manufacture. The Africa Centres for Disease Control and Prevention have called for the continent to be prioritised for vaccines, saying it is again being left behind. If the rest of the world had paid more attention to monkeypox in Africa in the past, it would be less of a problem for them now.

Public institutions need to do more to provide care to everyone. As Steven Thrasher, the author of The Viral Underclass, has written, ‘we all share the responsibility of life on a planet with viruses. But those of us living without the most lethal types of them must shoulder the responsibility more.’