Conflict Alerts # 535, 28 July 2022
Emmanuel Royan In the news
On 23 July, the Director-General of World Health Organization (WHO) Tedros Adhanom Ghrebeyesus designated the ongoing monkeypox outbreak as a Public Health Emergency of International Concern (PHEIC). Tedros stated: “We have an outbreak that has spread around the world rapidly through new modes of transmission about which we understand too little and which meets the criteria in the international health regulations.”
Issues at large
First, increase in monkeypox cases worldwide. For the first time, several monkeypox clusters have been recorded simultaneously in endemic and non-endemic countries since May 2022. The outbreak has over 16,000 cases across 75 countries. Most cases have been recorded in countries where there has never before been evidence of monkeypox transmission. The occurrence of cases and chains of transmission in countries with no immediate or direct epidemiological ties to West or Central Africa regions is a first. Bermuda, Thailand, Serbia, Georgia, India, Saudi Arabia, and Bermuda have all reported their first cases since 14 July, bringing the total number of countries where the current epidemic has been identified to 73.
Second, issues with tracing and testing. A study in the New England Journal of Medicine found that anonymous sex has been a significant challenge in contact tracing, with only 28 per cent of men able to provide the names of all recent sexual contacts. Data in Canada, Spain, Portugal, and the UK suggest places, where men have sex with multiple partners, are increasing the spread of the outbreak. Regarding testing, the Centers for Disease Control and Prevention official guidelines recommend that labs test for monkeypox using only samples of a patient’s skin taken from the visible rash. As a result, people whose fever and swollen lymph nodes show up a few days before their lesions must wait until the illness grows before it can be diagnosed. Therefore, people without symptoms will be left to wait and wonder, after an exposure, whether they could be infected.
Third, the availability of vaccinations. According to the CDC, historical evidence from Africa indicates that smallpox vaccination is at least 85 per cent effective in preventing monkeypox. The European Commission approved the Danish biotech company Bavarian Nordic’s Immunovex vaccine against Monkeypox in the EU member states. Bavarian Nordic has agreed to provide 2.5 million doses to a US contract manufacturer who will complete their manufacturing. The agreement would add to a previous purchase of three million doses of vaccine by early 2023, produced in Denmark, and would ensure the availability of vaccines in the fall. By mid-2023, over seven million doses will have been administered.
In perspective
First, early awareness of the outbreak’s concern. Although the WHO’s emergency committee meeting on 24 July lacked consensus regarding the assessment of the virus, the director-general took the call to declare that the outbreak was an international concern. The director-general was also not reluctant to say that the virus is predominant in the gay community, without any concerns for stigmatization.
Second, the “wait and see” approach of governments. Announcing public health emergencies may end up costing the nation affected by the epidemic financially, particularly if travel and trade are restricted. Several countries are hesitant to exchange public health information in the event of an outbreak due to their concern over such actions. Too many countries adopt a "wait and see" attitude when it comes to such announcements, pushing them off until it is too late, as was the case with COVID-19.