OSUN, Nigeria
As health authorities in Europe and elsewhere roll out vaccines and drugs to stamp out the biggest monkeypox outbreak beyond Africa, some doctors acknowledge an ugly reality: The resources to slow the disease’s spread have long been available, just not to the Africans who have dealt with it for decades.
Countries including Britain,
Spain, Portugal, Italy, Switzerland, the United States, Israel and Australia
have reported more
than 250 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 more than five 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.
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.” - AP
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