Science ignored by the world

After a case of monkeypox Exploded last month In countries where outbreaks do not normally occur, such as Portugal, Spain and the United Kingdom, rapid and global response continues. Including vaccine distribution in some countries.. However, monkeypox outbreaks have occurred in parts of Central and West Africa for years, and African researchers say that such resources are not available in the countries most affected by the disease. I was disappointed. They point out that they have long warned that the monkeypox virus, which is acting in new ways, could spread more widely.

So far this year, more than 3,000 cases of monkeypox have been identified in countries other than Central and West Africa, but no deaths have been reported. But in Africa, health officials have reported more than 70 deaths suspected to be caused by monkeypox. Dimie Ogoina, an infectious disease specialist at Niger Delta University in Amassoma, Nigeria, says this is probably an underestimate due to her limited testing and monitoring capabilities.

Although dissatisfied with the fact that monkeypox has been largely ignored by Western countries, Ogoina is worried that the current global epidemic may not improve the situation in Africa. “If we don’t get the world’s attention on this, many solutions will address the European problem, but not in Africa,” he says.

Outbreak experience

Prior to this year, only a handful of cases of monkeypox were observed outside Africa. These were related to the import of animals from the continent or the travelers who visited. The largest of these outbreaks was the short-term outbreak in the United States in 2003, which caused more than 70 people to become ill due to imported animals.

Meanwhile, some African countries have dealt with the outbreak of monkeypox since scientists identified the first human case in the Democratic Republic of the Congo (DRC) in 1970. It circulates among many species of rodents and can be transmitted from animals to humans. A serious outbreak began in Nigeria in 2017, with more than 200 confirmed cases of monkeypox and more than 500 suspected cases. Over the last decade, DRC has experienced thousands of suspicious cases and hundreds of suspicious deaths. In Central Africa, the monkeypox virus strains that infect people are more toxic, with a mortality rate of about 10%.

For Adesola Yinka-Ogunleye, an epidemiologist at the Centers for Disease Control and Prevention in Abuja, the current global outbreak has given déjà vu. Prior to the 2017 outbreak in Nigeria, the virus appeared to be confined to rural areas, where hunters were in contact with animals. It signals its presence with “chickenpox” lesions filled with heat and characteristic fluids on the face, hands and feet. Since 2017, she and other epidemiologists have warned¹ That the virus was spreading in an unfamiliar way: it was manifested in an urban environment, and infected people sometimes had genital lesions. This suggests that the virus may spread through sexual contact. Now that the virus is spreading in western cities through close contact with sexual partners, she says in 2017, “the world is paying for it because it didn’t respond properly.”

Immune weakness

At the same time, researchers warn that monkeypox cases have increased over the years in sub-Saharan Africa. In part, the country has stopped providing vaccines for smallpox. Smallpox is caused by smallpox, a virus closely related to the virus that causes monkeypox. Smallpox was eradicated in 1980 and vaccination was discontinued. This means that the proportion of the population vulnerable to smallpox and therefore monkeypox is increasing (see “Monkeypox Increasing Cases in Africa”).

Since then, some countries have maintained a national stockpile of smallpox vaccine. This is because health officials are concerned that laboratories storing smallpox samples could accidentally release smallpox or the virus could be weaponized. Countries, including Canada, France, the United Kingdom and the United States, are using these stockpiles in “ring vaccination” strategies to protect close contact with people infected with the monkeypox virus. Having admitted that there have been many cases of men having sex with men (MSM) so far, several Canadian cities and UK authorities have taken a step further and have begun to provide vaccines to the MSM community. rice field.

Steve Ahuka, a virologist at Kinshasa University, said these vaccines would help combat outbreaks in Africa, but Africa lacks large stockpiles and Western countries use them for monkeypox. Not donating shots for. Both Ahuka and Yinka-Ogunleye have stated that when vaccinated, they recommend at least front-line healthcare professionals and laboratory technicians.Other researchers Nature He also said that giving shots to people with weakened immunity and those who frequently encounter wildlife may help control monkeypox in Africa.

Lack of investment

Some health officials in sub-Saharan Africa are worried that they may continue to be left behind, judging by the experience of vaccine unfairness during the COVID-19 pandemic. Although the number of cases is increasing, only 18.4% are vaccinated with the coronavirus SARS-CoV-2 in Africa, compared to 74.8% in other high-income countries.

Members of the World Health Organization (WHO) have promised government agencies to administer more than 31 million smallpox vaccines for smallpox emergencies, but these are Africa for use against monkeypox. Has never been distributed to. Part of the reason, WHO’s monkeypox technology leader Rosamund Pike, says that some of the authorities’ pledged stockpile consists of “first-generation” vaccines. These can cause serious side effects and are not recommended for monkeypox, which is less deadly than smallpox. (Lewis refused to identify the exact composition of the WHO’s pledged stockpile.)

She also cites “regulatory issues.” This is because some member states only license vaccines for smallpox, not monkeypox. (Vaccines are considered safe and effective for people infected with smallpox, but testing for monkeypox is limited.)

“The investment was probably not what we wanted, but it was nothing,” Lewis said of his efforts to tackle monkeypox in Africa. She added that WHO is coordinating with African countries with monkeypox outbreaks to improve surveillance and diagnosis.

In recent weeks, WHO has been aware of the global attention inequality that monkeypox is experiencing. June 17, Announced by the agency Reflecting the “unified response needed”, monkeypox cases and deaths in sub-Saharan Africa and other countries are no longer reported separately.And after the researcher Announce proposal Rename monkeypox virus strain — now known as West African Clade and Congo Basin Clade — WHO Director Tedros Adhanom Ghebreyesus Came out to support the change, To reduce stigma. He promised to “announce the new name as soon as possible.”

But even if sub-Saharan African countries procure vaccines, vaccination alone cannot eradicate monkeypox, says Oyeware Tomori, an independent viralist in Ibadan, Nigeria. He warns that vaccination is only effective if health authorities understand the epidemiology of the area of ​​the pathogen. There are still many questions about how isolated cases of the disease continue to occur in sub-Saharan African affected countries. He supports studies to investigate monkeypox animal depots and recommends that health authorities devise more accurate measures to control the spread of the virus. “If you don’t address the underlying problem, you’ll be using all the vaccines against monkeypox,” he says. Instead of dealing with the cause of the problem, the contact between wildlife and humans.

Equally important are strategies for speeding up monkeypox testing. The sooner the case is confirmed, the sooner public health authorities can initiate containment measures, Ogoina says. He adds that these advances cannot come fast enough for sub-Saharan Africa. “An isolated solution that solves the problem in developed countries alone and excludes developing countries will lead us back to the same cycle,” he warns, pointing out past outbreaks of pathogens that continue to reappear. To do. “It’s just a matter of time.”