Introduction
As of June 2022, over 2103 cases of monkeypox have been reported in 11 countries outside of areas where it is typically endemic. Prior to 2022, the UK had only ever reported 7 cases of monkeypox, but as of this month, the country has 793 confirmed cases. The strand related to the spread has been sequenced and found to be distinct from the strand typical in West Africa, which causes milder symptoms but is more infectious.
Monkeypox is a rare viral disease spread by close contact by small airborne droplets with symptoms including a fever, rash and swollen lymph nodes. The zoonotic virus earns its name from being first detected in laboratory monkeys in 1958 and is thought to transmit from wild animals to people. With a risk of death between 0-11%, there is no known cure, though the smallpox vaccine is about 85% effective against infection in close contact.
Experts believe monkeypox is unlikely to be a repetition of the devastation on the scale caused by the COVID-19 pandemic: it does not transmit from person-to-person as readily, and due to its relation to the smallpox virus there are existing treatments that can be used to combat its spread. Therefore, despite monkeypox still being a cause for concern, it is not yet a cause for widespread panic.
However, that has not prevented the public health response and discussion about monkeypox being infected with old stigmas.
Response and Reporting
The first known case of Monkeypox in humans occurred in 1970 in the Democratic Republic of Congo. Since then, it has been primarily associated with west and central Africa, however the majority of early cases outside the region in the present outbreak occurred in gay and bisexual men.
The causes for this are currently unknown. Presently, European authorities are investigating men’s saunas and crowded Pride festivals, such as celebrations in the Canary Islands of Spain and Belgium, as partial sources for the outbreak. The composition of the outbreak is complicated and not entirely conclusive, however, this had not stopped inaccurate health reporting from taking place. Many outlets, such as the emphasised the source of the outbreak among queer people as a ‘reason’ for the outbreak, which has been highlighted by many as being unfortunately evocative of the initial reporting of pneumocystic pneumonia in clusters of gay men with AIDs forty years ago in 1981. This is despite official health authorities such as Colin Brown, director of the clinical and emerging infections at the UK Health Security Agency, has stated that monkeypox does not spread easily nor is generally considered a sexually transmitted infection, though it can be passed in “close personal contact with an infected symptomatic person”. The World Health Organisation has also confirmed monkeypox is not a sexually transmitted infection nor exclusive to queer men.
Irresponsible reporting in the name of accuracy can be harmful; when a disease or condition is associated with a marginalised group, people may not risk coming forward for fear of being associated or outed. This can be seen in the early days of HIV epidemic, when individuals who contracted the virus went underground and did not seek out medical care. However, the issue is complicated: while acknowledging that diseases of any kind are a wider threat that can affect anyone can reduce stigma and encourage people to come forward, it can also reduce specific resources for communities that still may genuinely need them the post.
The LGBT community is not the only one in which misplaced reporting on the monkeypox outbreak has caused harm: racial and global economic disparities in global healthcare have also been highlighted. WHO was recently forced to change its official monkeypox pictures, after African doctors and advisors pointed out that, despite the concern being over the global outbreak, all the pictures used were of Black people.
The Democratic Republic of Congo is the country that has been dealing with the world’s largest, most persistent and most deadly strain of monkeypox outbreak by far, with at least 1238 cases and 57 deaths this year and a fatality rate of 10%. Many of these deaths are preventable, but still occur due to underfunded hospitals and lack of horses. Some African doctors feel monkeypox has only become a high priority for the medical community now that individuals in the Global North are being affected by the outbreak. The Biden administrations has purchased 119 millions dollars worth of the smallpox vaccine, which has been licensed for use against monkeypox, after the first American case of monkeypox and European countries are strongly considering stockpiling antivirals. This is reminiscent of the COVID-19 outbreak, in which Canada bought enough vaccines to vaccinate its entire population 9 times over, but countries such as Uganda and Bangladesh still faced severe vaccine shortages, with only 17% of Africans fully vaccinated. The unequal distribution of healthcare resources is a long-standing issue and continues to be seen with the outbreak of monkeypox today.
The Way Forward
Challenges lie ahead. Despite stressing that the monkeypox outbreak does not resemble the early days of the COVID-19 pandemic because it does not transmit as easily, WHO does expect more monkeypox cases.
Reporting on monkeypox being accurate and careful is not just a matter of not perpetuating stigma, but avoiding misinformation and misleading health advice. Health officials have stressed the need to communicate very clearly to the public and the health response will likely have to look beyond vaccination and focus on quarantine, isolation and community education.
Despite comparisons to the lacking and dangerous response to the HIV/AIDS epidemic, there are important differences in the health response today and that of forty years ago. For example, UNAIDs has explicitly come out and condemned the racist reporting around the recent outbreak, with deputy executive director Matthew Kavanaugh stating, “Stigma and blame undermine trust and capacity to respond effectively during outbreaks like this one. Experience shows that stigmatising rhetoric can quickly disable evidence-based response by stoking cycles of fear, driving people away from health services, impeding efforts to identify cases, and encouraging ineffective, punitive measures.” Statements released by trusted outlets such as the BBC have also explicitly stated that monkeypox is not sexually transmitted. A related discussion most also occur in relation to the global and economic inequalities of pandemic responses and distribution of medical resources, with increased investment in deprived areas of world that may need it the most. These measures are the ones that health officials emphasises will allow for the most co-ordinated, effective and informed health response to the monkeypox outbreak.
Ishika Jha, Youth Medical Journal 2022
References
[1] Isidro, J. (2022). First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal). [online] Virological. Available at: https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799.
[2] Petersen, Brett W.; Damon, Inger K. (2020). “348. Smallpox, monkeypox and other poxvirus infections”. In Goldman, Lee; Schafer, Andrew I. (eds.). Goldman-Cecil Medicine. Vol. 2 (26th ed.). Philadelphia: Elsevier. pp. 2180–2183
[3] Sheikh, K. (2022). How Serious Is Monkeypox? The New York Times. [online] 23 May. Available at: https://www.nytimes.com/article/monkeypox-virus-covid.html.
[4] UK Health Security Agency (2022). Monkeypox: background information. [online] GOV.UK. Available at: https://www.gov.uk/guidance/monkeypox#:~:text=Monkeypox%20was%20first%20discovered%20in
[5] Porter, J. (2022). Let’s Set the Record Straight on Monkeypox, Gay Men, and HIV. [online] The Body: HIV/AIDs Resource. Available at: https://www.thebody.com/article/monkeypox-outbreak-hiv-gay-men-media.
[6] UK Health Security Agency (2022). Monkeypox: background information. [online] GOV.UK. Available at: https://www.gov.uk/guidance/monkeypox#:~:text=Monkeypox%20was%20first%20discovered%20in
[7] World Health Organisation (2022). Monkeypox: public health advice for gay, bisexual and other men who have sex with men. [online] http://www.who.int. Available at: https://www.who.int/news/item/25-05-2022-monkeypox–public-health-advice-for-gay–bisexual-and-other-men-who-have-sex-with-men.
[8] Mills, D. (2016). How the AIDS Epidemic Actually Began. [online] Healthline. Available at: https://www.healthline.com/health-news/how-aids-epidemic-actually-began.
[9] Villarosa, L. (2017). America’s Hidden H.I.V. Epidemic. The New York Times. [online] 6 Jun. Available at: https://www.nytimes.com/2017/06/06/magazine/americas-hidden-hiv-epidemic.html.
[10] Paquette, D. and Ombuor, R. (2022). As monkeypox panic spreads, doctors in Africa see a double standard. [online] The Washington Post. Available at: https://www.washingtonpost.com/world/2022/05/24/africa-europe-monkeypox-virus-outbreak/.
[11] Zitser, J. (2022). African journalists condemn media outlets for using images of Black people in coverage of US, UK monkeypox outbreaks. [online] Insider. Available at: https://www.insider.com/monkeypox-african-journalists-condemn-media-over-images-of-black-people-2022-5
[12] Browne, E. (2022). U.S. buys millions of monkeypox vaccines as Massachusetts man infected. [online] Newsweek. Available at: https://www.newsweek.com/monkeypox-cased-uk-massachusetts-case-vaccine-ordered-us-1708075
[13] Huet, N. (2022). This monkeypox antiviral drug may soon be in high demand. [online] euronews. Available at: https://www.euronews.com/next/2022/05/20/monkeypox-outbreak-drugmaker-siga-says-eu-authorities-seeking-to-stockpile-its-smallpox-an
[14] Gill, P. (2020). Canada has enough COVID-19 vaccine doses to cover each citizen five times over while the fate of 67 poor countries remains undecided. [online] Business Insider. Available at: https://www.businessinsider.in/science/health/news/canada-has-enough-covid-19-vaccine-doses-to-cover-each-citizen-five-times-over-while-the-fate-of-67-poor-countries-remains-undecided/articleshow/79645493.cms.
[15] Li, Z., Lu, J. and Lv, J. (2021). The Inefficient and Unjust Global Distribution of COVID-19 Vaccines: From a Perspective of Critical Global Justice. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, p.004695802110609. doi:10.1177/00469580211060992.
[16] Take Action (2022). Data dive: The astoundingly unequal global COVID-19 response. [online] ONE. Available at: https://www.one.org/africa/issues/covid-19-tracker/explore-covid-response/#:~:text=17.3%25%20of%20the%20population%20of%20the%20continent%20is%20fully%20vaccinated
[17] British Broadcasting Company (2021). Covid: Vaccines running out in poorer nations, WHO says. BBC News. [online] 21 Jun. Available at: https://www.bbc.co.uk/news/world-57558401.
[18] Rigby, J. (2022). WHO expects more cases of monkeypox to emerge globally. Reuters. [online] 21 May. Available at: https://www.reuters.com/article/us-health-monkeypox-who-idCAKCN2N70D4 [Accessed 29 Jun. 2022].
[19] Kozlov, M. (2022). Monkeypox vaccination begins — can the global outbreaks be contained? Nature. [online] doi:10.1038/d41586-022-01587-1.
[20] Branswell, H. (2022). ‘Nobody wants to mess this up’: A WHO official weighs in on the challenges of responding to monkeypox. [online] STAT. Available at: https://www.statnews.com/2022/06/01/monkeypox-response-challenges-maria-van-kerkhove-who/
[21] Kampalath, V. (2022). Monkeypox is recapitulating the stigma and structural inequity of HIV, Ebola, and other diseases. [online] STAT. Available at: https://www.statnews.com/2022/06/05/monkeypox-recapitulating-stigma-structural-inequity-of-hiv-ebola-other-diseases/
[22] Al Jazeera (2022). UN denounces ‘racist’ and ‘homophobic’ coverage of monkeypox. [online] http://www.aljazeera.com. Available at: https://www.aljazeera.com/news/2022/5/23/racist-and-homophobic-coverage-of-monkeypox-un-denounces?fbclid=IwAR0XPOOULQoIuo19n1cRQ9bUsdcoHs0Mu9DDSkEA7Hy2SP5bFbwUN5YySBE&sf165152932=1
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