The Shift in the Global Monkeypox Crisis and the African Outbreak
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The Decline of Monkeypox in the West
In May of last year, the World Health Organization declared the multi-country monkeypox outbreak, which initiated in 2022, as no longer a Public Health Emergency of International Concern. However, an unprecedented situation has emerged in the Congo.
Historically, monkeypox has been a neglected disease, confined predominantly to West and Central Africa. This changed dramatically in 2022, when it triggered a widespread outbreak that captured global attention for two consecutive years. The virus primarily spread among homosexual and bisexual men, which raised significant concerns regarding stigmatization and its impact on public perception.
Currently, the transmission of monkeypox has subsided in Europe and the Americas for two key reasons. First, those most at risk—men who engage in sexual activity with other men—have effectively reduced their risk of exposure. Second, vaccination campaigns using the recently approved Imvanex vaccine have proven successful.
Despite concerns that monkeypox could become endemic in these regions, such fears have not come to fruition, which is encouraging for areas where the virus is not typically found. Yet, this decline in cases has led to diminishing public interest, leaving African countries, particularly the Congo, to contend with the issue largely on their own.
The Rising Outbreak in the Congo
Since January 2023, the Democratic Republic of the Congo (DRC) has been grappling with its most extensive monkeypox outbreak to date, with over 12,000 suspected cases reported by November. Alarmingly, this outbreak has extended into provinces that had never previously recorded cases.
For the first time, sexual transmission of the virus from Clade I (the Congo basin Clade) has been documented in the region, a troubling development as this is the more virulent of the two known clades.
However, in stark contrast to wealthier nations where vaccines became readily accessible, no doses of the monkeypox vaccine have reached Africa. This situation raises serious concerns about health equity, as countries in Europe and North America have hoarded the limited supply of vaccines, leaving African nations without support—mirroring the inequities witnessed during the Covid-19 pandemic.
To date, only South Korea has committed to donating vaccines to the African Centers for Disease Control and Prevention (CDC), yet no vaccines have actually been delivered. This situation highlights the international community's failure to provide adequate assistance.
The Dilemma of Vaccine Access
The issue is compounded by the long-standing neglect of monkeypox on the continent. Within the context of diseases affecting Africa, such as AIDS and malaria, monkeypox remains a low priority.
According to the Washington Post, Bavarian Nordic—the manufacturer of Imvanex—reported that it had not been contacted by African nations regarding vaccine procurement in the past two years. Additionally, as the vaccine is not approved in any African country, including the DRC, there are liability concerns that hinder the sale or donation of these vaccines to the region.
Stigma and Its Impact
Stigmatization against gay men may also be exacerbating the epidemic in the Congo. Overall, attitudes toward homosexuality are more negative in African countries compared to Europe and the Americas. While homosexuality is not illegal in the DRC, it is criminalized in many parts of Africa, including neighboring Uganda, where a man currently faces the death penalty for charges of aggravated homosexuality.
This societal stigma can hinder preventive measures aimed at high-risk individuals, such as vaccinations, as people may avoid seeking treatment due to fear of discrimination. The rebranding of monkeypox as mpox, intended to address concerns over racist stigma, is unlikely to resolve these issues.
The ongoing internal and external challenges continue to enable mpox to impact the lives of many. With each failure to control outbreaks in endemic countries, the threat of a new global outbreak becomes increasingly likely.
The Global Perspective on Monkeypox
This video from BBC News discusses the WHO's declaration of the mpox outbreak as a global health emergency, shedding light on the current state of the crisis.
In this video, WHO officials emphasize the mpox outbreak in Africa as an international public health emergency, detailing the implications for global health.
For additional insights, explore my comprehensive articles on monkeypox (mpox) published in Microbial Instincts:
Microbial Instincts
Decoding the microbial angle to health and the microbial world. (Under Medium’s Boost pilot program.)
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