Spread of monkeypox puts us all at risk

Hoarding vaccines in rich countries is counter productive and dangerous

Monkeypox, a zoonotic infection related to smallpox, has been getting a lot of attention this month, and rightfully so. The occurrence of cases in many countries around the world where it has never been seen before is concerning, although not entirely unexpected.

Glaringly, almost all the attention is on cases in wealthy countries. The tragic deaths and the increasing burden of the disease in impoverished regions in the world continue to be largely neglected.

If we have learned anything from COVID, it is that we are globally interconnected and the spread of infectious diseases anywhere in the world puts us all at risk. Other than perhaps multibillionaires who have more personal wealth than some entire countries, we are all, to some degree, in the same proverbial boat.

In the setting of international neglect, the numbers of cases and deaths from monkeypox in central and western regions of Africa have increased dramatically since the 1970s, when the first cases were diagnosed in the Democratic Republic of Congo.

The number of cases has increased more than 10-fold over the past 10 years. In 2017, after 40 years without any cases, monkeypox re-emerged in Nigeria. Since January 2022, the World Health Organization estimates that, in the Congo alone, at least 57 people died and over 1,200 people became sick with monkeypox. There has been little attention in the worldwide media to these deaths.

The reasons for the increasing number of cases in Africa are likely related to ecology, deforestation, civil unrest, and poverty — which force more interactions between people and rodents/ animals that are the natural hosts of the monkeypox virus. Combined with the cessation of smallpox vaccination in the 1980s and the subsequent waning of immunity, this means that populations are now more susceptible to monkeypox.

Monkeypox, although less infectious and less severe than smallpox, is closely related, and countermeasures such as vaccines and therapeutics already exist, in very limited supplies. In fact, the United Kingdom has rolled out vaccines for people identified as close contacts of active cases.

Canada and many other wealthy countries may follow suit, and have a stockpile of these countermeasures. But, once again, hoarding vaccines in wealthy non-endemic countries while neglecting disease spread and increasing cases in endemic countries is a strategy that is doomed to fail in the long term.

The relative neglect of deaths and rising numbers of cases in other regions of the world where the virus is endemic continues to be a problem. It is in our collective self-interest and our health security to ensure that access to health care, surveillance, vaccination and therapeutic interventions primarily reach regions of the world most affected by this disease.

This takes a recognition that we are a global community, and that we need to co-ordinate and co-operate in our response to emerging infections.

We would be deluding ourselves if we think we can end the risks associated with monkeypox, COVID, avian influenza, and other zoonotic diseases without addressing the drivers of infectious diseases and spillovers, including inequity, poverty, deforestation, climate change and our interactions with animals as a global community.

Jan Hajek is an infectious diseases specialist at Vancouver General Hospital; Victor Leung is in the department of pathology and laboratory medicine at the University of B.C.; Srinivas Murthy is in the department of pediatrics at the University of B.C.