It was May 7th when the first case in the current outbreak of monkeypox was diagnosed in the UK. That’s almost three months since the disease began to make its presence felt outside Africa. Three months since a surge was noted in countries with no obvious travel link to areas where it was already endemic. Three months of frightened, isolated individuals hearing the mantra that the symptoms were “mild” and there was a “low risk” of community spread.
Three months for us to intuit that lesions and pustules in the mouth and genital area must be anything but “mild” for those experiencing them — some describe the pain as excruciating; similarly the fevers, headaches, muscle aches, swollen lymph nodes, chills and exhaustion; and the three weeks — yes, weeks — of isolation for symptomatic cases. For contrast, think of the fuss when Covid patients were advised to isolate for a week while carrying a virus capable of putting others’ lives at risk.
The odd thing about monkeypox — spread by close, skin-to-skin contact — has been the strangely disconnected narrative around it, which kept it bobbing around the news reports but never quite landing as a legitimate concern for the wider population.
The disconnect was probably rooted in the best of motives to begin with — to avoid labelling and stigmatising the groups overwhelmingly affected so far: gay and bisexual men.
But enough was known to allow the wider community to largely ignore it.
In that sense, it feels unsettlingly familiar.
Unlike Covid-19, which required the invention of new vaccines, there is an effective vaccine already available for monkeypox
Perhaps that’s because the term “low risk of community spread” in this context is another way of saying that “It is spreading in my communities, communities of gay and bisexual men — and this suggests that these communities don’t matter”, in the words of Dr John Gilmore, assistant professor at UCD’s school of nursing, midwifery and health systems. Perhaps because “mild” in this context means that while it is painful, frightening and isolating, it is usually a self-limiting illness, probably won’t kill anyone and is therefore nothing for the wider population to get rattled about.
No doubt this will seem unfair to overworked public health officials well aware of the indelible lessons about stigma, cruelty and ignorance that history has stamped on this particular community. If this group happens to be particularly sensitive to public messaging, it’s hardly surprising. If solutions such as vaccines and drugs are available but are not being targeted urgently and decisively at those known to be most at risk the group should be furious.
Vaccine availability
Unlike Covid-19, which required the invention of new vaccines, there is an effective vaccine already available for monkeypox.
An antiviral drug originally used against smallpox is also being trialled successfully. But it seems to be too late for containment. While New York City, for example, was rushing to contain the disease a month ago, the view is that it was already too late even then. The good news is that they — and the NHS — are now pushing out tens of thousands of vaccines to sexually active gay men. In Ireland, the government has just announced the extension of vaccination to men in high risk groups.
Last Thursday, when the World Health Organisation’s director general declared a “public health emergency of international concern” — the highest level in its hierarchy of warnings — he used language that deserves close attention. “We have an outbreak that has spread around the world rapidly through new modes of transmission about which we understand too little and which meets the criteria in the international health regulations”, said Dr Tedros Adhanom Ghebreyesus, who had to pull rank on the majority in the group.
One advantage of the WHO’s emergency alert will be more transparency over which countries are getting their hands on the vaccines, from limited supplies
Separately, in a study of 528 cases — of which 13 per cent were hospitalised for pain management but threw up no serious complications in the majority — the rare complications that did arise prompted the authors to suggest further study of the full spectrum of the disease, according to the New England Journal of Medicine.
Monkeypox doesn’t sound so simple any more. The pain, fear and isolation suffered by gay and bisexual men for several months has officially become an urgent global concern. There are now more than 16,000 reported cases in 75 countries. On Friday the US identified its first two cases in children. While severe illness and death outside Africa were always regarded as unlikely, people with very weak immune systems, pregnant women and very small babies are known to be vulnerable to severe illness from the disease.
One advantage of the WHO’s emergency alert will be more transparency over which countries are getting their hands on the vaccines — made by Bavarian Nordic, a Danish company — from limited supplies. Just about half those reporting cases have secured some. The WHO’s big test will be how to channel the vaccines to where they are needed the most.
Up to 2022 monkeypox was just another chronically underfunded, neglected tropical infection — but we were able to ignore it because it was happening in Africa, where the number of human monkeypox cases has been increasing since the 1970s. This could be due to the halt in smallpox vaccinations — our own programme ceased in 1972 — and other familiar factors such as deforestation, disruption of animal habitats and human mobility.
Remember the lesson from Covid-19. No one is safe until everyone is safe.