Countries including Britain, Spain, Portugal, Italy,
Switzerland, the United States, Israel and Australia have reported more than
500 monkeypox cases, many apparently tied to sexual activity at two recent
raves in Europe. No deaths have been reported.
Authorities in numerous European countries and the U.S. are
offering to immunize people and considering the use of antivirals. On Thursday,
the World Health Organization will convene a special meeting to discuss
monkeypox research priorities and related issues.
Meanwhile, the African continent has reported about three
times as many cases this year.
There have been more than 1,400 monkeypox cases and 63
deaths in four countries where the disease is endemic — Cameroon, Central
African Republic, Congo and Nigeria — according to the Africa Centers for
Disease Control and Prevention. So far, sequencing has not yet shown any direct
link to the outbreak outside Africa, health officials say.
Monkeypox is in the same family of viruses as smallpox, and
smallpox vaccines are estimated to be about 85% effective against monkeypox,
according to WHO.
Since identifying cases earlier this month, Britain has
vaccinated more than 1,000 people at risk of contracting the virus and bought
20,000 more doses. European Union officials are in talks to buy more smallpox
vaccine from Bavarian Nordic, the maker of the only such vaccine licensed in
Europe.
U.S. government officials have released about 700 doses of
vaccine to states where cases were reported.
Such measures aren’t routinely employed in Africa.
Dr. Adesola Yinka-Ogunleye, who leads Nigeria’s monkeypox
working group, said there are currently no vaccines or antivirals being used
against monkeypox in her country. People suspected of having monkeypox are
isolated and treated conservatively, while their contacts are monitored, she
said.
Generally, Africa has only had “small stockpiles” of
smallpox vaccine to offer health workers when monkeypox outbreaks happen, said
Ahmed Ogwell, acting director of the Africa CDC.
Limited vaccine supply and competing health priorities have
meant that immunization against monkeypox hasn’t been widely pursued in Africa,
said Dr. Jimmy Whitworth, a professor of international public health at the
London School of Hygiene and Tropical Medicine.
“It’s a bit uncomfortable that we have a different attitude
to the kinds of resources we deploy depending on where cases are,” he said. “It
exposes a moral failing when those interventions aren’t available for the
millions of people in Africa who need them.”
WHO has 31 million doses of smallpox vaccines, mostly kept
in donor countries and intended as a rapid response to any re-emergence of the
disease, which was declared eradicated in 1980. Doses from the U.N. health
agency’s stockpile have never been released for any monkeypox outbreaks in
central or western Africa.
Dr. Mike Ryan, WHO’s emergencies chief, said the agency was
considering allowing rich countries to use the smallpox vaccines to try to
limit the spread of monkeypox. WHO manages similar mechanisms to help poor
countries get vaccines for diseases like yellow fever and meningitis, but such
efforts have not been previously used for countries that can otherwise afford
shots.
Oyewale Tomori, a Nigerian virologist who sits on several
WHO advisory boards, said releasing smallpox vaccines from the agency’s
stockpile to stop monkeypox from becoming endemic in richer countries might be
warranted, but he noted a discrepancy in WHO’s strategy.
“A similar approach should have been adopted a long time ago
to deal with the situation in Africa,” he said. “This is another example of
where some countries are more equal than others.”
Some doctors pointed out that stalled efforts to understand
monkeypox were now complicating efforts to treat patients. Most people
experience symptoms including fever, chills and fatigue. But those with more
serious disease often develop a rash on their face or hands that spreads
elsewhere.
Dr. Hugh Adler and colleagues recently published a paper
suggesting the antiviral drug tecovirimat could help fight monkeypox. The drug,
approved in the U.S. to treat smallpox, was used in seven people infected with
monkeypox in the U.K. from 2018 to 2021, but more details are needed for
regulatory approval.
“If we had thought about getting this data before, we
wouldn’t be in this situation now where we have a potential treatment without
enough evidence,” said Adler, a research fellow at the Liverpool School of
Tropical Medicine.
Many diseases only attracted significant money after
infecting people from rich countries, he noted.
For example, it was only after the catastrophic Ebola
outbreak in West Africa in 2014-2016 — when several Americans were sickened by
the disease among the more than 28,000 cases in Africa — that authorities
finally sped up the research and protocols to license an Ebola vaccine, capping
a decades-long effort.
At a press briefing on Wednesday, WHO’s Ryan said the agency
was worried about the continued spread of monkeypox in rich countries and was
evaluating how it could help stem the disease’s transmission there.
“I certainly didn’t hear that same level of concern over the
last five or ten years,” he said, referring to the repeated epidemics of
monkeypox in Africa, when thousands of people in the continent’s central and
western parts were sickened by the disease.
Jay Chudi, a development expert who lives in the Nigerian
state of Enugu, which has reported monkeypox cases since 2017, hopes the
increased attention might finally help address the problem. But he nevertheless
lamented that it took infections in rich countries for it to seem possible.
“You would think the new cases are deadlier and more
dangerous than what we have in Africa,” he said. “We are now seeing it can end
once and for all, but because it is no longer just in Africa. It’s now
everybody is worried.”