LONDON — As the World Health Organization’s emergency committee met on Thursday to consider for the second time in weeks whether to declare monkeypox a global crisis, some scientists said the stark differences between epidemics in Africa and in developed countries would complicate any coordinated response.
African officials say they are already treating the continent’s outbreak as an emergency. But experts elsewhere say the mild version of monkeypox in Europe, North America and beyond makes an emergency declaration unnecessary even if the virus cannot be stopped. British authorities recently downgraded their assessment of the disease, given its lack of severity.
“I remain concerned about the number of cases, in an increasing number of countries, that have been reported,” WHO Director-General Tedros Adhanom Ghebreyesus told the emergency committee as its meeting began.
He said it was “pleasant” to note the decline in the number of monkeypox cases in some countries, but the virus continues to rise elsewhere and six countries reported their first infections in the past week.
Monkeypox has been entrenched for decades in parts of West and Central Africa, where diseased wild animals occasionally infect rural dwellers in relatively contained outbreaks. The disease in Europe, North America and beyond has been circulating since at least May among gay and bisexual men. The outbreak in wealthy countries was likely sparked by sex at two raves in Spain and Belgium.
Some experts worry that these and other differences will deepen existing medical inequalities between poor and rich countries.
There are now over 15,000 cases of monkeypox worldwide. While the United States, Britain, Canada and other countries have bought millions of vaccines, none have gone to Africa, where a more serious version of monkeypox has already killed more than 70 people. Rich countries have yet to report any deaths from monkeypox.
“What’s happening in Africa is almost entirely separate from the outbreak in Europe and North America,” said Dr Paul Hunter, professor of medicine at Britain’s University of East Anglia, who previously advised the WHO on infectious diseases.
The UN health agency said this week that outside of Africa, 99% of all reported monkeypox cases are in men and of these, 98% are in men who have sex with men. other men. Yet the disease can infect anyone in close physical contact with a monkeypox patient, regardless of sexual orientation.
“In these very active gay sex networks, you have men who really, really don’t want people to know what they’re doing and maybe don’t always know who they’re having sex with,” Hunter said.
Some of these men may be married to women or have families who are unaware of their sexual activity, which ‘makes contact tracing extremely difficult and even things like asking people to come in for a test’ , Hunter said, explaining why vaccination may be the most effective way. to stop the epidemic.
This is probably not the case in Africa, where limited data suggests that monkeypox is mainly spread among people from infected animals. Although African experts acknowledge they may be missing cases among gay and bisexual men, given the limited surveillance and stigmatization of LGBTQ people, authorities have relied on standard measures such as solitary confinement and education to control the disease.
Dr Placide Mbala, a virologist who heads the global health department at Congo’s National Institute for Biomedical Research, said there are also notable differences between patients in Africa and the West.
“We see here (in Congo) very quickly, after three to four days, visible lesions in people exposed to monkeypox,” Mbala said, adding that it’s unlikely that someone with that many visible lesions will come out alive. public, thus preventing transmission.
But in countries like Britain and the United States, doctors have observed some infected people with just one or two lesions, often in their genitals.
“You won’t notice that if you’re just with that person in a taxi or a bar,” Mbala said. “So in the West, people without these visible lesions can silently spread the disease.”
He said different approaches in different countries will likely be needed to stop the global outbreak, making it difficult to adopt a single response strategy around the world, like those for Ebola and COVID-19.
Dr Dimie Ogoina, a professor of medicine at the Niger Delta University in Nigeria, said he feared that limited vaccine stocks around the world could lead to a repeat of the problems experienced during the coronavirus pandemic, when poorer countries have been left empty-handed after rich countries have hoarded. most doses.
“It doesn’t make sense to only control the epidemic in Europe and America, because then you will still have the (animal) source of the epidemic in Africa,” said Ogoina, who sits on the emergency committee of WHO against monkeypox.
This week, US officials said more than 100,000 doses of the monkeypox vaccine were being sent to states in the coming days, with several million more on order for the coming months. The United States has reported more than 2,000 cases so far, with hundreds more being added every day.
Some US public health experts have begun to question whether the epidemic is becoming widespread enough for monkeypox to become a new sexually transmitted disease.
Declaring monkeypox a global emergency could also inadvertently worsen the vaccine rush, despite the mildness of the disease seen in most countries.
Dr Hugh Adler, who treats monkeypox patients in Britain, said there were not many cases or serious infections apart from gay and bisexual men. Still, he said it was frustrating that more vaccines were not available, as the outbreak was doubling around every two weeks in the UK.
“If reclassifying monkeypox as a global emergency will make (vaccines available) then maybe it’s the right thing to do,” he said. “But in an ideal world, we should be able to do the necessary interventions without the declaration of emergency.”