On August 14, 2024, the World Health Organization (WHO) classified the monkeypox virus as a “global health emergency.” This decision was driven by the increasing number of cases among children and adults in more than 12 countries, particularly with the spread of a new strain. This development has reignited fears that the virus could escalate into a global epidemic or pandemic similar to the COVID-19 pandemic, raising concerns about the potential for another round of worldwide lockdowns.
The Nature of the Disease:
Available data on the globally spreading monkeypox virus highlights its health risks, which could pose challenges to healthcare systems in many countries. Key information about monkeypox includes:
Definition: The WHO defines monkeypox, commonly abbreviated as MPXV, as a disease caused by the monkeypox virus, which belongs to the orthopoxvirus family. This family also includes smallpox, cowpox, and other viruses. The virus has two genetic clades: Clade I and Clade II.
Symptoms: Monkeypox causes a range of symptoms, varying in severity. While most cases present manageable symptoms, the virus can cause severe complications in pregnant women, children, and immunocompromised individuals, necessitating care in a healthcare facility (quarantine). In some cases, the disease can be fatal, with data indicating mortality rates ranging from 0.1% to 10% among those infected. It’s important to note that mortality rates can vary in different environments due to factors such as healthcare availability and immunity levels.
Modes of Transmission and Spread: Monkeypox can infect people of all ages. Although it is not a respiratory virus, monkeypox can be transmitted through respiratory secretions. The virus can also spread to humans from infected wild animals through direct contact with the animal’s blood, bodily fluids, or skin/mucosal lesions, or by consuming meat from an infected animal. Additionally, the virus can spread through contact with objects used or touched by an infected person, and it can be transmitted between humans through physical contact or sexual activity. Pregnant women can also transmit the virus to their fetus.
Treatment and Vaccination: Individuals infected with monkeypox often recover within three weeks, although some may require healthcare. Infected individuals need to be vaccinated with available vaccines. There are two vaccines against monkeypox: the first, known as Jynneos (mpox), is a two-dose vaccine and is the only one specifically approved by the U.S. Food and Drug Administration (FDA) for this use. It is produced by the Danish company Bavarian Nordic, but supplies are extremely limited and expensive. The U.S. distributed this vaccine for free in 2022 and later made it commercially available. The other vaccine, ACAM2000, carries higher risks of side effects and is not suitable for mass immunization.
The WHO does not recommend mass vaccination for monkeypox as it did for COVID-19. Instead, it advises using the polio vaccine to immunize close contacts of monkeypox patients and healthcare workers at risk of exposure.
Rapid Developments:
WHO data indicates that monkeypox is not a new disease. It was first discovered in 1958 when the virus was identified in monkeys held for research in Denmark. Later, in 1970, the first human case was detected in a nine-month-old child in the Democratic Republic of the Congo (DRC). By 1980, monkeypox had been eradicated, and vaccination against the virus ceased worldwide. However, this did not prevent the disease from resurfacing, with cases appearing sporadically in Central, Eastern, and Western Africa. Since 2022, new global waves of infection have emerged.
The virus’s elevation to a global emergency status is linked to the emergence of a new strain (Clade II), which has spread beyond the DRC. This strain is transmitted through sexual contact and presents milder symptoms. This development coincides with the spread of dengue fever, endemic in Central and West Africa, which resembles smallpox but is less contagious. The virus primarily spreads through close contact with infected animals or humans and the consumption of contaminated meat.
Since the beginning of this year, over 18,000 cases have been confirmed across Africa. The African Union’s health agency announced that a total of 18,737 probable or confirmed cases of monkeypox had been recorded across Africa since the start of the year, including 1,200 cases in one week. Earlier this week, the Africa Centers for Disease Control and Prevention (Africa CDC) declared that the monkeypox outbreak constitutes a public health emergency, following over 500 reported deaths, and called for international assistance to halt the virus’s spread.
Urgent Response:
Following the declaration of monkeypox as a global health emergency, there have been growing calls for the provision of monkeypox vaccines, particularly since these vaccines are available in developed countries but not in the African countries most affected by the virus. Moreover, the prices of these vaccines are significantly high. For example, the Minister of Health in the DRC, Roger Kamba, requested approximately 3.5 million doses of monkeypox vaccines to halt the virus’s spread, as the DRC needs to vaccinate 2.5 million people to control the disease.
The Danish biotechnology company Bavarian Nordic confirmed its intention to increase the production of its monkeypox vaccine and work with international health organizations to ensure equitable access to the vaccine. The company stated that it had informed the Africa CDC of its ability to produce 10 million doses of the vaccine by the end of 2025 and supply up to 2 million doses this year. The company also announced plans to expand its production network to include Africa and expressed its readiness to collaborate with the Africa CDC and WHO to make the vaccine accessible to all countries.
The Limits of Pandemic Potential:
The WHO’s declaration of a global health emergency concerning monkeypox has raised concerns about the potential for the virus to become a pandemic, similar to COVID-19. It has also sparked fears of another general lockdown and the strain on current healthcare systems, which have not yet fully recovered from the COVID-19 crisis. However, many experts believe these concerns may not be realistic or likely, given the fundamental differences between COVID-19 and monkeypox (as outlined in Table 1). This distinction could influence the international community’s approach to addressing the current health emergency.
Here’s a table (01) comparing the key differences between COVID-19 and mpox:
| Characteristic | COVID-19 | Mpox |
|---|---|---|
| Causative Agent | SARS-CoV-2 virus (RNA virus) | Mpox virus (DNA virus) |
| Spread | Primarily through respiratory droplets and aerosols[1][4] | Mainly through close physical contact with infected persons or animals, or contaminated materials[1][4] |
| Transmissibility | Highly transmissible[1] | Less transmissible than COVID-19[1] |
| Incubation Period | 2-14 days[1] | 5-21 days[1] |
| Main Symptoms | Fever, cough, difficulty breathing, fatigue, loss of taste/smell[1] | Fever, rash progressing to fluid-filled blisters, swollen lymph nodes[1] |
| Severity | Varies widely, from asymptomatic to severe[1] | Generally milder, but can be severe in some cases[1] |
| Mortality Rate | Varies by variant and population, generally higher than mpox[1] | 1-10%, depending on strain and region[1] |
| Vaccination | Multiple specific vaccines available and widely administered[1] | Smallpox vaccine provides some protection; specific mpox vaccines available for outbreaks[1] |
| Mutation Rate | High (RNA virus)[4] | Lower (DNA virus)[4] |
| Global Impact | Widespread pandemic affecting millions[5] | Limited outbreaks, lower overall impact[5] |
The previous table shows that the international community has better opportunities to achieve an effective response to monkeypox compared to its response to the COVID-19 crisis. The availability of tested vaccines, slower transmission rates, and the slow mutation rate of the virus may provide enough time for many countries to take necessary preventive measures or control the outbreak.
It is also clear that there are opportunities to mitigate the pressure of the virus’s spread on healthcare systems. The disease may not require widespread quarantine as was necessary with COVID-19, potentially allowing for cost savings that could be directed toward purchasing vaccines or producing them locally. Furthermore, the likelihood of a general lockdown, as seen during the COVID-19 pandemic, appears lower as long as there is some level of control over the spread of the virus and no rapid genetic mutations in the virus variants.
Evaluations:
Based on the above, several evaluations can be made regarding the potential risks of the global health emergency caused by monkeypox and the challenges of addressing them:
- Monkeypox represents a new challenge for current systems in the wake of recovering from the COVID-19 crisis. The spread of monkeypox serves as a test of how well-prepared healthcare systems are to handle new outbreaks and emergencies. Countries should have learned from the COVID-19 experience to improve their healthcare system performance and restructure their infrastructure to provide a better response to such situations.
- Monkeypox presents a challenge for health and healthcare funding. Preventive measures against the virus require adequate funding and resources, especially in countries with weak economies, given that vaccine prices are high and supplies are limited.
- Monkeypox will be another test to assess the level of coordination between global and local health organizations to ensure a rapid and effective response to the spread. Efforts must be combined to achieve an adequate level of international and regional emergency response.
- Monkeypox raises questions about the fairness of vaccine distribution between rich and poor countries. It also raises the issue of developing scientific research and vaccine production in third-world countries, and the extent to which these countries can develop their healthcare and research systems.
In conclusion, the development of monkeypox risks at the regional and international levels will depend on the responsiveness of countries to this emergency, the extent of achieving cooperation and collective response, the promotion of equitable vaccine distribution among countries, and encouraging nations to produce vaccines beyond the limited capacity. There will also be a moral and health obligation to provide funding to economically weak countries to achieve a swift national response to combat the disease before it spreads beyond their borders.
Citations:
[1] https://www.indiatoday.in/health/story/mpox-vs-covid-19-is-there-a-difference-should-you-be-worried-2586197-2024-08-22
[2] https://dergipark.org.tr/en/download/article-file/3230116
[3] https://dph.illinois.gov/topics-services/diseases-and-conditions/mpox/about-mpox/mpox-comparison.html
[4] https://link.springer.com/article/10.1007/s40257-023-00778-4
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10141174/
[6] https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Mpox-vs-COVID19.aspx
