Covid’s dark shadow hangs over a lurking new danger

WE are still talking about how Covid-19 was managed, even though the disease itself is almost forgotten. In the US election in November, vaccines, mandatory mask-wearing and lockdowns will once again be contentious issues. The prominent anti-vaxxer  Robert F Kennedy Jr will gain even more attention now that he's aligning himself with Donald Trump. The credibility of established institutions such as the World Health Organisation (WHO) and the US Centers for Disease Control, and all those who like to rely on scientifically proven facts, continues to be questioned regularly.

Therefore, much of the reaction to the WHO's second declaration of Mpox as an international health emergency was entirely predictable. Here are some of the comments readers posted this week under a Netwerk24 article about it:

“Blah blah blah WHO. Few people still believe you have noble intentions."

“The same experts who freaked out the world for no reason in 2020-2023."

“Yay, here comes another lockdown."

There’s even a conspiracy theory that Mpox was invented by “them” to conceal new Covid cases. To beat a disease like this, it’s clearly just as important to win the fight against ignorance, prejudice, selfishness and the unequal distribution of resources as it is to develop the right medicine and treatment.

Here are some of the questions that frequently arise about Mpox:

Is this another new disease that wasn’t known before?

Yes and no. “Monkeypox” is caused by a virus that has been around for a long time. It’s related to smallpox but is usually less severe. Monkeypox was first identified in 1958 among monkeys kept for research purposes, hence the name. Rodents and other smaller animals also often get sick from it, but transmission to humans was first recorded in 1970. After a new series of outbreaks among humans in 2022, the WHO decided to combat the negative associations with monkeys and the resulting stigmatisation of the disease by renaming it Mpox.

What is new, however, is the rapid spread of forms of the virus known as clades 1b and 2b. These versions are mutations and now appear in areas where authorities have little experience of them or the resources to identify and combat them. Cases have recently been reported for the first time in Burundi, Kenya, Rwanda and Uganda.

Clade 2Ib caused the outbreak from July 2022 to May 2023 in several regions, including Europe and Asia, as well as the first case not associated with travel from Africa (in 2022 in Britain). By the time this emergency was declared over, cases had been recorded in 118 countries, 111 of which were non-endemic for Mpox. A total of 87,377 cases were recorded.

How serious is it?

The original clade 1 has been causing sporadic outbreaks of Mpox for decades, especially in the Democratic Republic of Congo (DRC), with children often being more affected than adults. The recent mutations not only cause more severe illness, but researchers also know much less about things like exactly how they're transmitted and why they're occurring in areas where Mpox was previously unknown. The latest available mortality rate is about 3.6% of cases.

What are the symptoms?

The most prominent symptom of Mpox is a distinctive rash in the form of pustules on the skin. It can also cause fever, headache, swollen lymph nodes, muscle aches and fatigue, which in some cases develop before the rash. It can be fatal, especially among children and other vulnerable groups and if it is diagnosed and treated too late. The infection lasts for two to three weeks and can clear up on its own, though it often leaves lasting scars.

Why has the WHO again declared it an emergency?

Two main reasons. First, because more cases and deaths are occurring in new locations, and second, because emergency status unlocks certain resources that can be used to combat the disease.

Several African countries have developed significant expertise in combating diseases like smallpox, yellow fever, Ebola, Mpox and Covid over the past few decades. This is usually done through enhanced surveillance, rapid laboratory confirmation of cases, tracing of other people who have been in contact with a carrier, isolation of the sick and public awareness. This requires effective communication, coordinated response and dedicated leadership. When all these factors are present, large-scale vaccination campaigns are often unnecessary.

Since Mpox is now striking in areas where local experts have little or no experience with it, these factors are often lacking, and the more they are lacking, the faster the virus spreads. Additional resources can therefore help to extend existing expertise to other countries so the infection can be contained before it becomes an even bigger problem.

The Africa Centres for Disease Control and Prevention (Africa CDC) has recorded more than 14,500 infections and 450 deaths due to Mpox since the beginning of the year. Until the end of July, most were in the DRC. This represents a 160% increase in infections and a 19% increase in deaths compared to the corresponding period last year.

South Africa has recorded 24 cases and three deaths. Nineteen people have recovered and two active cases are in home isolation.

How is it spread?

The virus is spread through personal contact with someone who is infected. The outbreaks since 2022 have mostly been caused by sexual and other forms of close contact, according to the WHO. The virus can enter the body through an open wound or through the eyes, nose or mouth. It can also be spread through bedding, clothing and towels. Close contact with infected animals, such as monkeys, rats and squirrels, can also cause infection.

Is there a vaccine against Mpox?

Yes, but it’s usually only available to people who are already at risk or who have been in close contact with an infected person. Available vaccines were originally developed against smallpox but are effective against Mpox because the two are closely related. An antiviral drug, Tecovirimat, is available, although it was also originally developed against smallpox and in many places can be used against Mpox only in emergencies.

As usual, prevention is cheaper and more effective than post-care, but the less there is of the former, the more necessary the latter becomes.

Are we going the same way as with Covid?

Not necessarily, but there are similarities, and it’s possible that Mpox could develop into a pandemic. The Africa CDC estimates that 10 million doses of vaccines will be needed to stop the current outbreaks, but only a fraction of that number is available. Denmark’s Bavarian Nordic is one of only a few companies that produce an approved vaccine. An agreement between Africa CDC and the EU has already been reached for the procurement and rapid distribution of about 200,000 doses in Africa, but someone will have to decide where they are most needed and who will be skipped – inevitably leading to political conflict, just as with Covid-19.

As The New York Times wrote this week: “Another pandemic looms. Guess what? We’re still not ready.”

♦ VWB ♦

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