On July 23rd 2022 the global outbreak of monkeypox was declared a ‘Public Health Emergency of International Concern’ by the World Health Organization. Since January 1st 2022 there has been over 35,000 cases of monkeypox worldwide, with over 26,000 confirmed cases in 80 countries where the disease is not endemic, according to The Lancet.
Fortunately, the vast majority of those infected with monkeypox recover well without hospitalisation or intervention, as the disease proves rarely fatal. In this outbreak there has only been 12 reported deaths globally.
Monkeypox or (MPX) is caused by a virus closely related to smallpox and it is endemic to countries in West and Central Africa. Despite the name monkeypox the zoonotic virus is thought to be harboured in rodents and other small mammals which live in Africa.
Monkeypox is endemic to Africa and historically cases in other regions have been imported. However, in the 2022 outbreak viral transmission is occurring in over 80 countries worldwide, with a recent increase in case numbers across Western Europe, United States and Australia coinciding with festival seasons and Pride month – a celebration of LGBTQ communities.
Monkeypox can be spread when someone is in close contact with an infected person, however during this outbreak the spread has predominantly been through sexual intercourse. The virus can enter the body through broken skin, the respiratory tract or through the eyes, nose or mouth – particularly through shared bedding and clothing.
During the current outbreak of monkeypox the spread of the virus has predominately been in communities of gay and bisexual men and men who have sex with men. In many countries and societies across the world there is a social stigma associated with LGBTQ people.
This active discrimination means infected LGBTQ individuals often do not seek treatment quickly or at all for monkeypox. Furthermore, in some countries without equal access to healthcare, treatment is not simply not available to them.
Lack of research and barriers to care
The current global monkeypox outbreak has highlighted the lack of research around the disease. A systematic review in the British Medical Journal, concluded that there was a “ lack of evidence-based clinical management guidelines for MPX globally” and that “there is a clear and urgent need for research into treatment and prophylaxis including for different risk populations”.
Nature reported concern among infectious disease researchers in Nigeria that the monkeypox outbreak in Europe, and the western world, is overshadowing outbreaks in Africa – which have a much higher fatality rate.
Researchers are also concerned that the allocation of research budgets and vaccines against monkeypox virus to countries where the virus is not endemic is missing those who are most vulnerable, particularly among rural communities in Central and West Africa.
Internationally there are two approved smallpox vaccines which provide protection against the monkeypox virus the Jynneos vaccine – known as Imvamune/Imvanex in Europe – and ACAM2000, an older smallpox vaccine. Those who are at risk of contracting monkeypox have been advised to receive the vaccine, as the vaccine can lessen the severity of disease post-infection (Ferran 2022).
Despite repeat recommendations from the UN organisations vaccine equity across the world is out of reach. Thousands of covid-19 vaccines are still being made available to those low- and lower-middle income countries, researchers say that monkeypox vaccines should also be distributed to those more in need and not just to countries which can afford it.
On CABI Global Health using the search string "monkey pox" or "monkeypox" returns over 600 records on monkeypox including full text open access records.
Ferran, M., 2022. Monkeypox vaccines: A virologist answers 6 questions about how they work, who can get them and how well they prevent infection. The Conversation, [online] Available at: https://theconversation.com/monkeypox-vaccines-a-virologist-answers-6-questions-about-how-they-work-who-can-get-them-and-how-well-they-prevent-infection-188214 [Accessed 25 August 2022].
Max Kozlov. Monkeypox in Africa: the science the world ignored. Nature 607, 17-18 (2022) doi: https://doi.org/10.1038/d41586-022-01686-z
Taylor L. Monkeypox: Concerns mount over vaccine inequity BMJ 2022; 378 :o1971 doi: https://doi.org/10.1136/bmj.o1971
Webb E, Rigby I, Michelen M, et al Availability, scope and quality of monkeypox clinical management guidelines globally: a systematic review BMJ Global Health 2022;7:e009838. https://gh.bmj.com/content/7/8/e009838
Wenham, Clare et al. Monkeypox as a PHEIC: implications for global health governance. The Lancet, Volume 0, Issue 0 DOI: https://doi.org/10.1016/S0140-6736(22)01437-4