As the World Health Organization’s emergency committee met Thursday to consider for the second time in weeks whether to declare monkeypox a global crisis, some scientists said the striking differences between outbreaks in Africa and developed countries would complicate any coordinated response. 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 it unnecessary to declare an emergency even if the virus cannot be stopped. British officials recently downgraded their assessment of the disease, given its lack of seriousness. “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 “gratifying” that the number of monkeypox cases was falling in some countries, but that the virus was still on the rise elsewhere and that six countries had 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 circulating in Europe, North America and beyond since at least May among gay and bisexual men. The epidemic in rich countries was probably sparked by sex at two raves in Spain and Belgium. Some experts worry that these and other differences could potentially deepen 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 have gone to Africa, where a more serious 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 entirely separate from the outbreak 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 UN health agency said this week that outside Africa, 99% of all reported cases of monkeypox are in men, and of those, 98% are in men who have sex with men. However, the disease can infect anyone in close, physical contact with a monkeypox patient, regardless of their sexual orientation. “In these very sexually active gay networks, you have men who really, really don’t want people to know what they’re doing and they may not always know who they’re having sex with,” Hunter said. Some of these men may be married to women or have families who are unaware of their sexual activity, which “makes contact tracing, even things like asking people to come in for tests, extremely difficult,” said Hunter, explaining why vaccination may be the most effective way. to close the 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 may be missing among gay and bisexual men, given limited follow-up and anti-LGBTQ stigma, authorities have relied on standard measures such as isolation and education to control the disease. Dr Placide Mbala, a virologist who heads the global health department at Congo’s National Biomedical Research Institute, said there are 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 someone with so many visible lesions is unlikely to go out in public, thus preventing further transmission. But in countries like Britain and the US, doctors noticed some infected people with just one or two lesions, often on their genitals. “You wouldn’t notice this if you’re just with that person in a taxi or a bar,” Mbala said. “So in the West, people without these visible lesions may be silently transmitting the disease.” He said it would likely take different approaches in different countries to stop the global epidemic, making it difficult to adopt a single global response strategy, like those for Ebola and COVID-19. Dr Dimie Ogoina, a professor of medicine at Nigeria’s Niger Delta University, said he feared the world’s limited supplies of vaccines would lead to a repeat of the problems seen in the coronavirus pandemic, when poorer countries were left empty-handed after rich ones piled on. countries. most of the doses. “It doesn’t make sense to just control the outbreak in Europe and America, because then you still have the (animal) source of the epidemic in Africa,” said Ogoina, who sits on the WHO’s monkeypox emergency committee. . This week, US officials said more than 100,000 doses of monkeypox vaccine were being shipped to the states in the coming days, with several million more ordered for the coming months. The US has reported more than 2,000 cases so far, with hundreds more being added every day. Some US public health experts have begun to question whether the outbreak is becoming widespread enough for monkeypox to become a new sexually transmitted disease. Declaring monkeypox a global emergency could also inadvertently exacerbate the rush for vaccines, despite the mild disease seen in most countries. Dr Hugh Adler, who treats monkeypox patients in Britain, said there were not many serious cases or infections beyond gay and bisexual men. However, he said it was disappointing that more vaccines were not available as the outbreak was doubling roughly every two weeks in the UK. “If reclassifying monkeypox as a global emergency is going to make (vaccines available), then maybe that should be done,” he said. “But in an ideal world, we should be able to make the necessary interventions without declaring an emergency.”
