Monkeypox: Is it still possible to stop the monkeypox outbreak?

Monkeypox (monkeypox) took the world by surprise.

It has long been present in parts of central and western Africa, where people live near forest animals that carry the virus.

But now it’s gone global — it’s spreading in ways never seen before and on an unprecedented scale. There have been more than 27,000 confirmed cases of the disease, mostly in men who have sex with men, in 88 countries.

The World Health Organization (WHO) says this is a global emergency. So can monkeypox be stopped? Or are we doomed to have another virus spreading across the world?

WHO’s technical lead for monkeypox, Dr. Rosamund Lewis says it is “possible” to end the outbreak, but warns that “we don’t have a crystal ball” and it is unclear whether the organization will be able to “support countries and communities enough to stop this outbreak”.

To understand the case, there are three aspects that we need to consider:

• Is the virus particularly difficult to deal with?
• Do we have the ability to stop it?
• Is there a willingness to face a disease that mainly affects gay and bisexual men?

The virus

There is nothing special about the biology of the monkeypox virus. It is not an unstoppable force.

Covid probably was — it spread so readily that it was impossible to contain even in the early days of the pandemic.

But monkeypox has a harder time passing from one person to another. Needs close physical contact—such as through infected skin, prolonged personal contact, or contaminated surfaces, such as a sheet or towel.

The two viruses have different characteristics, and previous monkeypox outbreaks have just disappeared. And we’ve already overcome the far greater challenge of defeating the virus’s deadly cousin, smallpox.

“Monkey smallpox is easier (to deal with) as it is less transmissible than smallpox, so we are in a much better position,” said Professor Jonathan Ball, a virologist at the University of Nottingham in the UK.

However, one problem is that some people have mild symptoms or symptoms that can easily be mistaken for a sexually transmitted disease or chickenpox. This means it can be unintentionally passed on to others.

The tools

The virus has entered a group of people who are having enough sex or having enough intimate contact with enough partners for the virus to overcome its own inadequacies and be able to spread.

The virus is not classified as a sexually transmitted infection. But a study in the New England Journal of Medicine estimated that 95% of monkeypox infections were being acquired through sex, particularly sex between men.

Sex, of course, is full of all the intimate skin-to-skin contact that the virus uses to spread.

That leaves two options for containing the disease —persuading people to have less sex; or to reduce the risk of getting the infection when there is exposure.

Professor Paul Hunter, from the University of East Anglia (UK), said: “The easiest way to avoid this is to shut down all highly active sexual networks for a few months until it disappears, but I don’t think that will ever happen – do you? “

Some people adjust their sex lives in response to warnings about monkeypox, and the advice has been aimed at people most at risk. But Professor Hunter argues that the lesson of sexually transmitted infections — from syphilis in the Middle Ages to now — is that people still have sex and “vaccination is pretty much the only option.”

Fortunately, the smallpox vaccine that was used to eradicate this virus is about 85% effective in preventing monkey pox.

There are limited supplies as stocks are kept in case someone uses smallpox as a weapon, not to fight an unprecedented outbreak of monkeypox.

However, not everyone at risk would need to be vaccinated to stop the outbreak. “Herd immunity” means that once a critical threshold of people is protected, the virus can no longer spread. This will be much easier to achieve with smallpox than with other diseases — including Covid.

People

While anyone can catch monkeypox, it is gay, bisexual and other men who have sex with men who are disproportionately affected in this outbreak.

This can make it easier to control the virus, as it is generally a more informed group about sexual health. It also allows resources to be targeted to those in need — such as vaccinating men who have sex with men rather than the entire population.

However, stigma, discrimination and abuse can prevent people from seeking help, particularly in countries where sex between men is illegal.

“Some countries don’t have the infrastructure and some may not want to get tested for monkeypox, because they are men who have sex with men,” said Professor François Balloux of University College London in the UK.

There are still challenges in countries that support LGBT rights — lesbian, gay, bisexual and transgender. Even policies like asking people to self-isolate — measures we are so familiar with due to Covid — can have unintended consequences.

“This is tantamount to coming out — whether to a wife or parents (since you suddenly have to explain why) — so there’s a lot of pressure not to say who your contacts were,” Professor Hunter said.

So can monkeypox be contained?

Some countries already appear to be getting the virus under control. The UK, for example, says the number of infections appears to have stabilized at around 35 a day. But cases continue to rise elsewhere, including the United States, which has declared an emergency.

But it will not be enough just for rich countries to control the virus when it is now in more than 80 countries that do not have a long history of the disease.

“It’s not very clear to me whether this will be fully controlled, some countries will be on top of it, others won’t,” Balloux said.

WHO’s technical lead for monkeypox, Dr. Rosamund Lewis says it’s “possible” to end the outbreak, but warns that “we don’t have a crystal ball” and it’s unclear whether the organization will be able to “support countries and communities enough”. enough to stop this outbreak.”

Countries such as the United Kingdom, Spain and the United States have already started vaccination campaigns against monkeypox, but there is still no forecast of when the first doses should arrive in Brazil.

According to the Our World In Data portal, Brazil had registered 1,721 cases of monkeypox as of August 3.

Endemic countries in Africa — where monkeypox is ever-present — will continue to grapple with the virus as it continually jumps from wild animals to people.

Studies have shown that the problem is getting worse since the smallpox eradication program ended, as few people under the age of 50 have been immunized.

The only thing that would stop that would be a mass vaccination campaign, “but there’s a lot of debate in Africa as to whether that’s appropriate or necessary,” says Professor Hunter.

What happens if we don’t stop the virus?

The concern is that smallpox could become a permanent presence in people all over the world, not just in countries with infected animals.

At the moment, this is mostly related to men having sex with men, but the longer the outbreak continues, the more likely the virus is to establish itself more widely.

There have been isolated cases in children and women, but these cases have not started their own outbreaks in classrooms or workplaces. However, the risks increase as the virus has time to get better at infecting people. We have witnessed how covid has evolved and variants like the omicron have become much better at infecting us.

“Unless the virus changes, I personally doubt it will spread to children or, more generally, people who don’t have many sexual partners,” Balloux said. “But the longer the wait, the greater the risk that this will change,” he said.

The other issue is that monkeypox has a knack for infecting a wide variety of mammals, including squirrels, mice, voles and monkeys in Africa. There is a danger that the virus could establish itself in other animals and start jumping between species. The monkeypox outbreak in the US in 2003 — which led to 47 cases in six states — was caused by prairie dogs (a type of rodent native to North America) used as pets.

Fighting this monkeypox outbreak is possible, but the longer we let it go, the harder it gets and the greater the risk.

This text was originally published here.