Monkeypox vaccine has fierce dispute and does not arrive soon, says secretary of SP

Infectologist David Uip, 70, secretary of Science, Research and Development in Health of the São Paulo government, says that there is a fierce dispute around the world for the monkeypox vaccine and that it should not arrive in Brazil in the short term.

This Saturday (23), the WHO (World Health Organization) declared the disease a public emergency of global concern, and the Minister of Health, Marcelo Queiroga, said that the federal government is already negotiating the purchase of the immunizer through PAHO (Organization Pan American Health).

Another alternative, according to Uip, is for the immunizing agent to be manufactured in Brazil by the Farmanguinhos laboratories (Fiocruz) and the Butantan Institute, which created a technical committee to study vaccine production. On June 9, researchers from USP released the genetic sequencing of the monkeypox virus (MPXV), which causes smallpox in monkeys.

“But from there until transforming it into IFA (Active Pharmaceutical Ingredient), into production and storage capacity, it takes time. The news I had is that the possibility of having a new vaccine in Brazil is nine months,” he says.

In the short term, Uip says it is necessary to train the health network for the diagnosis and treatment of cases, which involves isolation for three weeks. He advocates special attention to pregnant women because there are already studies associating the virus (monkeypox) with a greater risk of miscarriage.

According to him, actions against the stigma and prejudice that can surround the disease are also important, since the highest prevalence has been higher among men who have sex with men.

“That was a disaster in the past [com a epidemia de Aids]. There are already many cases that have nothing to do [com transmissão sexual]. There are already cases where the contact involved was bed linen, towels. This story cannot be thought of simply. The speed of transmission and the forms of contagion are quite frightening,” he says.

In his position as secretary since May, Uip is responsible for integrating epidemiological surveillance, assistance, research, teaching and production of new vaccines and medicines to combat infectious diseases.

What changes with the WHO declaring monkeypox as public emergency of concern global? This unifies the difficulties and, thus, solutions appear, including the readjustment and distribution of vaccines, resources and the compatibility of public programs between countries.

The Minister of Health, Marcelo Queiroga, declared that the country is already negotiating the purchase of vaccine with PAHO. Is the way? the danish vaccine [Imvanex] is being disputed all over the world. The United States increased the order, the European Union as well. Then we have to get in line. I don’t see any other alternative and I don’t see anything in the short term. The ministry is negotiating with the same difficulties.

Even via Oops? It may be that with the declaration of global emergency that will change. By the usual ways, the expectation was long. The other alternative, if possible, is for Farmanguinhos and Butantan to produce the vaccine.

The virus has already been isolated, but it takes time to transform it into an API, into production and storage capacity. The news I had is that the possibility of having a new vaccine in Brazil is nine months. Butantan created a committee to monitor cases of the disease in the state and evaluate the production of a vaccine against the disease.

And in the short term, what needs to be done? First, prepare the system to be able to diagnose and attend to these cases both from the point of view of Basic Health Units (UBS) to referral hospitals. Emilio Ribas [na capital paulista] it has passed 200 cases for more than a week.

Some cases will be treated at home, others will need to be hospitalized due to the exuberance of symptoms. I am very concerned about vulnerable populations, such as immunocompromised and pregnant women. Every time you diagnose, it requires long isolation, about three weeks.

Mr. mentioned pregnant women. Are there any special recommendations for this group? There are cases in the literature showing that if a pregnant woman acquires this virus, she is more likely to have a miscarriage. It is still not possible to know if the abortion was because they had the virus, but it is a warning. The other situation is in the peripartum. If the woman is infected during this period, the indication is for a cesarean section.

Are there already protocols in Brazil on clinical procedures to be adopted for different audiences? We, in the field of health, are trying to protocol everything, even communication protocol. You have to warn, you have to show, but you cannot create panic.

How to combat the issue of stigma since the disease has been more frequently diagnosed among MSM (men who have sex with men)? We can’t make the mistakes of the past [durante a epidemia de Aids], thinking it is a disease of an isolated population. That was a disaster, and this stigma and prejudice bill we pay to this day.

the transmission [entre homens que fazem sexo com homens] it may be the beginning, but not only. There are already many cases that have nothing to do [com transmissão sexual]. There are already cases where the contact involved was bed linen, towels. This story cannot be thought of simply. The speed of transmission and forms of contagion are quite frightening.

What do you already know about forms of contagion other than sexual? The virus can be transmitted by touching wounds caused by the infection or by close and prolonged contact with respiratory secretions from infected people. Therefore, wearing a mask is very important.

Initial symptoms, such as fever, enlarged lymph nodes, and redness in the body, resemble those of other illnesses. Then come the vesicles (bubbles). You’re just not contagious the moment all the lesions become crusty.