LONDON –
As the World Health Organization’s emergency committee met on Thursday to debate for the second time in weeks whether to declare monkeypox a global crisis, some scientists said the striking differences between outbreaks in Africa and in developed countries would complicate any coordinated response. reaction.
African officials say they are already treating the continent’s outbreak as an emergency. But experts elsewhere say the mild version of monkeypox in Europe, North America and beyond makes declaring a state of emergency unnecessary, even if the virus cannot be stopped. British officials recently downgraded their assessment of the disease due to its lack of severity.
“I remain concerned about the number of cases in an increasing number of countries that have been reported,” WHO Director-General Tedros Adhanom Ghebreyesus told the emergency committee as it began its meeting.
He said it was “pleasant” to note a drop in the number of monkeypox cases in some countries, but that the virus was still increasing elsewhere and that six countries reported their first infections last week.
Monkeypox has been established for decades in parts of central and west Africa, where diseased wild animals occasionally infect people in rural areas in relatively limited outbreaks. The disease has been spreading in Europe, North America and beyond since at least May among gay and bisexual men. The epidemic in rich countries was probably triggered by sex at two raves in Spain and Belgium.
Some experts worry that these and other disparities could exacerbate existing medical disparities between poor and rich nations.
There are now more than 15,000 cases of monkeypox worldwide. While the United States, Britain, Canada and other countries have bought millions of vaccines, none has gone to Africa, where a more severe version of monkeypox has already killed more than 70 people. Rich countries have yet to report deaths from monkeypox.
“What’s happening in Africa is almost completely different from the epidemic in Europe and North America,” said Dr. Paul Hunter, a professor of medicine at Britain’s University of East Anglia who previously advised the WHO on infectious diseases.
The U.N. health agency said this week that outside Africa, 99 percent of all reported monkeypox cases are in men, and of those, 98 percent are in men who have sex with men. However, the disease can infect anyone who is in close physical contact with a monkeypox patient, regardless of their sexual orientation.
“In these very active gay sex networks, there are men who really, really don’t want people to know what they’re doing, and maybe they themselves don’t always know who they’re having sex with,” Hunter said.
Some of these men may be married to women or have families who don’t know about their sexual activity, which “makes contact tracing extremely difficult and even things like asking people to come forward for testing,” Hunter said, explaining why vaccination may be the most effective way to stop an outbreak.
This is probably not the case in Africa, where limited data suggest that monkeypox is primarily transmitted to humans from infected animals. Although African experts acknowledge that cases among gay and bisexual men may be missing, given the limited surveillance and stigmatization of LGBTQ people, authorities rely on standard measures such as isolation and education to control the disease.
Dr Placide Mbala, a virologist who heads the global health division at Congo’s Institute for National Biomedical Research, said there were also notable differences between patients in Africa and the West.
“We see here (in Congo) very quickly, after three to four days, visible lesions in people exposed to monkeypox,” Mbala said, adding that it was unlikely that someone with so many visible lesions would go out in public, as thus preventing further transmission.
But in countries including Britain and the US, doctors have seen some infected people with just one or two lesions, often on their genitals.
“You wouldn’t notice this if you were just with that person in a taxi or a bar,” Mbala said. “So in the West, people without these visible lesions may be quietly spreading the disease.”
He said different approaches would likely be needed in different countries to stop a global epidemic, making it challenging to adopt a single global response strategy, such as those for Ebola and COVID-19.
Dr. Dimi Ogoyna, a professor of medicine at Nigeria’s Niger Delta University, said he feared the world’s limited supply of vaccines would lead to a repeat of the problems experienced by the coronavirus pandemic, when poorer countries were left with empty hands after the rich countries accumulated them most of the doses.
“It doesn’t make sense to just control the epidemic in Europe and America because then you will still have the (animal) source of the epidemic in Africa,” said Ogoyna, who is a member of the WHO’s monkeypox emergency committee.
This week, US officials said more than 100,000 doses of monkeypox vaccine would be shipped to the states in the next few days, with several million more on order for the coming months. The US has reported more than 2,000 cases so far, with hundreds more being added every day.
Some American public health experts have begun to wonder whether the outbreak has spread widely enough to make monkeypox a new sexually transmitted disease.
Declaring monkeypox a global emergency may also inadvertently worsen the rush for vaccines, despite the mildness of the disease seen in most countries.
Dr. Hugh Adler, who treats monkeypox patients in Britain, said there were not many serious cases or infections other than gay and bisexual men. However, he said it was disappointing that more vaccines were not available as the outbreak was doubling every two weeks in the UK.
“If reclassifying monkeypox as a global emergency is going to make (vaccines available), then maybe that’s what needs to be done,” he said. “But in an ideal world, we should be able to make the necessary interventions without an emergency declaration.”
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