Monkeypox Hits A World Struggles to Bring Deadly COVID-19 Under Control

By May 1, 2021, the deadly COVID-19 pandemic had cost more than 3.2 million lives globally and had infected over 153 million people. As the world continues to fight the war against COVID-19, another virus known as monkeypox has started spreading in many countries. Unlike the coronavirus, monkeypox does not spread as easily and is not a leading cause of death. According to the World Health Organization (WHO), nearly 100 cases of monkeypox have been confirmed in over twelve countries, with the United Kingdom having the highest number. Though many cases are among gay and bisexual men, anyone can contract the virus through close personal contact.

Reports show that the UK Health Security Agency (UKHSA) confirmed the first case in the recent outbreak on May 7, impacting a man who had traveled to Nigeria, where the disease is prevalent. This was followed by six more cases. Four of those cases were among gay and bisexual men who had contracted the virus locally. As of May 23, UKHSA reported 70 confirmed cases in the country and one in Scotland.

Apart from the United Kingdom, many monkeypox cases have been reported in Spain and Portugal. Fewer numbers have been reported in European countries, Canada, the United States, and Australia. The monkeypox disease is very common in rural Central and West Africa. Informal data reveals more than 300 confirmed or suspected cases worldwide as of May 25.

The WHO has warned that more cases are likely to be reported. Although there is no vaccine for monkeypox, a smallpox jab offers 85% protection to all infected because the two viruses are similar.

The WHO has described the outbreak as atypical, as it has occurred in non-endemic countries. According to the WHO, "working with the affected countries and others to expand disease surveillance to find and support people who may be affected."

WHO's European regional director, Hans Kluge, has advised that "as we enter the summer season... with mass gatherings, festivals, and parties, I'm concerned that transmission could accelerate."

Meanwhile, the Ghana Health Service (GHS) has debunked claims of monkeypox detection in the country. The Service urged the public to disregard any such reports, saying some disease cases have been recorded in the Western Region. The GHS's announcement follows a viral social media post that alleged the country had recorded its first case, but Ghana has yet to record any case of the monkeypox disease.

According to the Acting Head of Disease Surveillance of the GHS, Dr. Dennis Laryea, the Service has strengthened surveillance to pick up, manage, and regulate necessary control measures should the country record any case.

The Ghanian Times interview of Dr. Laryea stated that the initial assessment of the case in the western region was not suggestive of monkeypox, but further investigations are ongoing. However, Dr. Laryea advised the public to stick to hand hygiene practices and wear masks, especially in enclosed places, because the mode of transmission of monkeypox is similar to COVID-19.

"The initial presentation is like most infectious diseases – fever, weakness, chills, etc. It is when the skin lesion sets in that people highly suspect monkeypox, but it's important that when people feel unwell, they self-isolate, especially when investigations have not been done to ascertain the cause," Dr. Laryea stressed.

Arguably, people with monkeypox usually recover without treatment. However, the recent outbreak in Europe and other parts of the world has a fatality rate of around 1 percent. In addition, monkeypox is more likely to cause severe illness in children, pregnant women, and immunocompromised people.

Monkeypox Background

Just like smallpox, monkeypox is not a new disease. It's mostly associated with rodents and is primarily seen in Central and West Africa. However, isolated cases are occasionally reported in Europe and elsewhere, often involving travelers. The current outbreak is the largest ever seen outside of Africa.

Though the smallpox vaccination prevents monkeypox, its cases have risen over the past few decades since routine smallpox vaccination was discontinued. As a result, the WHO declared that smallpox had been eradicated worldwide in 1980. This means only older people have vaccine-induced immunity.

Monkeypox causes flu-like symptoms such as fever, fatigue, muscle aches, swollen lymph nodes, and a rash. The rash can appear on the face, genitals, palms, soles of the feet, and elsewhere. The sores can be flat, raised, or pus-filled and may resemble other conditions such as herpes, syphilis, or chickenpox. The monkeypox virus has an incubation period of up to three weeks, and the illness lasts two to four weeks.

It is transmitted through close personal contact, including skin-to-skin contact and kissing. Such close contact may involve household members and health care workers. The virus can also spread via clothes or linens that have been in contact with fluid from sores.

Health officials say monkeypox can be transmitted via respiratory droplets at close range, but the virus does not appear to spread through the air over long distances in the same way as the SARS-CoV-2 coronavirus that causes COVID-19.

Interestingly, the general precautionary measures recommended against COVID-19 are also expected to protect from monkeypox virus transmission.

Countries like Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, and Ghana (identified in animals only) are monkeypox endemic countries. Others include the Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.

Even though monkeypox continues to spread, it cannot be compared to the deadly COVID-19, which claimed many lives globally.

The WHO SCORE assessment indicates that about 40 percent of the world's deaths remain unregistered, and 50 percent of countries have limited capacity for systematic monitoring of quality health care. Moreover, only 59 percent of countries have a good capacity to use data to drive policy and planning.

In addition, the COVID-19 pandemic highlighted the importance of closing existing data gaps with quality health information systems to help improve population and unpredictable health emergencies.

Through international cooperation like the COVAX initiative, the acceleration of development, production, and distribution of COVID-19 vaccines is underway in many countries.

However, fair and equitable access to vaccines is a major challenge because of the inequality across income groups. For example, only 1 percent of doses go to low-income countries (LICs) as compared to the 19 percent administered in lower-middle-income countries (LMICs), 33 percent in upper-middle-income countries (UMICs), and 47 percent in high-income countries (HICs) as of May 1, 2021. This challenge might affect WHO's efforts to attain a sustainable development agenda by 2030.

No one is safe until everyone is safe.