Africans see inequality in the response to monkeypox elsewhere

OSUN, Nigeria (AP) – While health authorities in Europe and elsewhere are releasing vaccines and drugs to tackle the largest monkey outbreak outside Africa, some doctors acknowledge the ugly reality: resources to slow the spread of the disease have long been available, just not for Africans who have been engaged in this for decades.

In countries such as the UK, Spain, Portugal, Italy, Switzerland, the United States, Israel and Australia, more than 250 cases of monkeypox have been reported, many of which appear to be related to sexual activity at two recent raves in Europe. No deaths were reported.

Authorities in many European countries and the United States are proposing to immunize people and are considering the use of antivirals. On Thursday, the World Health Organization convenes a special meeting to discuss the priorities of monkeypox research and related issues.

Meanwhile, more than five times as many cases have been registered on the African continent this year.

According to the African Centers for Disease Control and Prevention, more than 1,400 cases of monkeypox and 63 deaths have been reported in four countries where the disease is endemic – Cameroon, the Central African Republic, Congo and Nigeria. So far, the sequence has not shown a direct link to the outbreak outside Africa, health officials say.

Monkeypox belongs to the same family of viruses as smallpox, and WHO estimates that monkeypox vaccines are approximately 85% effective.

Since the discovery earlier this month, Britain has vaccinated more than 1,000 people at risk of contracting the virus and bought another 20,000 doses. Representatives of the European Union are negotiating to buy more smallpox vaccine from Bavarian Nordic, the maker of the only such vaccine licensed in Europe.

U.S. government officials have released about 700 doses of the vaccine to those states where cases have been reported.

Such measures are not commonly used in Africa.

Dr. Odesola Yinka-Ogunli, who chairs the working group on monkeypox, said her country does not currently use monkeypox vaccines or antivirals. People with suspected monkeypox are isolated and treated conservatively, and their contacts are monitored, she said.

Typically, Africa has only “small stocks” of smallpox vaccine that can be offered to healthcare professionals when monkey outbreaks occur, said Ahmed Ogwell, acting director of the African CDC.

Limited vaccine supplies and competing health priorities meant that monkeypox immunization was not widespread in Africa, said Dr Jimmy Whitworth, a professor of international public health at the London School of Hygiene and Tropical Medicine.

“It’s somewhat inconvenient that we have different attitudes towards the kinds of resources we use depending on where things are,” he said. “It exposes a moral error when these interventions are not available to the millions of people in Africa who need them.”

The WHO has 31 million doses of smallpox vaccine, mostly stored in donor countries and designed to respond quickly to any recurrence of a disease that was declared eradicated in 1980. Doses from the stockpiles of the UN Health Agency have never been released against monkeypox outbreaks in central or West Africa.

Dr Mike Ryan, WHO’s head of emergency, said the agency was considering allowing rich countries to use smallpox vaccines to try to limit the spread of monkeypox. The WHO is running similar mechanisms to help poor countries get vaccines against diseases such as yellow fever and meningitis, but previously such efforts have not been used for countries that could otherwise afford vaccinations.

Oewale Tomori, a Nigerian virologist on several WHO advisory boards, said releasing smallpox vaccines from the agency’s stockpiles to prevent monkeypox from becoming endemic in richer countries could be justified, but he noted the inconsistency of the WHO strategy .

“A similar approach had to be taken long ago to deal with the situation in Africa,” he said. “This is another example of some countries being more equal than others.”

Some doctors have noted that halted efforts to understand monkeypox are now complicating efforts to treat patients. Most people experience symptoms including fever, chills and fatigue. But people with more serious illnesses often have a rash on their face or hands that spreads elsewhere.

Dr. Hugh Adler and his colleagues recently published an article suggesting that the antiviral drug tecavirimate may help fight monkeypox. The drug, approved in the U.S. for the treatment of smallpox, has been used in seven people infected with smallpox in the UK from 2018 to 2021, but more details are needed for regulatory approval.

“If we had thought about getting this data before, we wouldn’t have found ourselves in a situation where we have a potential treatment without enough evidence,” said Adler, a researcher at the Liverpool School of Tropical Medicine.

Many diseases attracted significant money only after infecting people from rich countries, he noted.

For example, only after the catastrophic outbreak of Ebola in West Africa in 2014-2016 – when several Americans contracted the disease among more than 28,000 cases in Africa – authorities finally accelerated research and protocols for licensing the Ebola vaccine. , completing years of effort.

Jay Chudi, a development expert living in the Nigerian state of Enugu, who has reported cases of monkeypox since 2017, hopes that increased attention can finally help solve the problem. But he nonetheless complained that infections were needed in rich countries to make it seem possible.

“You think new cases are more deadly and dangerous than what we have in Africa,” he said. “Now we see that it can end once and for all, but because it’s not just in Africa anymore. Now everyone is worried. “

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Cheng reported from London. Kara Anna in Nairobi and Mike Stobbe in New York contributed to this report.

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