Monkeypox is not a one-off – here’s how we prepare for our new reality

Frequent smaller but significant outbreaks of new and reemerging diseases are almost certain to become a regular part of life

Monkeypox is yet another warning shot to the world. The virus’ rapid spread in recent weeks has highlighted the threat posed by emerging new infections, and shone a spotlight on gaps in the global response to tackling disease.

But although some parallels can be drawn to the coronavirus, monkeypox is almost certainly not the next Covid-19.

That fact was reflected by a committee of experts appointed by the World Health Organization, who met on June 23 to decide whether to raise the agency’s highest alarm.

I was part of this committee. We concluded that, while clearly an evolving threat meriting urgent attention, the current outbreak does not at this time constitute a “public health emergency of international concern”, or PHEIC. Tedros Adhanom Ghebreyesus, the WHO director-general, accepted the recommendation.

PHEICs have been declared on six previous occasions – most recently in January 2020, in the early days of the coronavirus pandemic. But monkeypox presents a very different situation. The virus is not so easily transmitted, and not so prone to mutations that can result in dangerous variants because it is a DNA virus, rather than an RNA virus like Covid-19.

Plus, thanks to the work that went into eradicating its cousin smallpox, we already have many of the tests, treatments and vaccines to control it.

But that does not mean we can discount the virus. While the committee’s decision makes sense, we also noted the sobering fact that monkeypox outbreaks have existed for years in Africa. Yet, it was only when the disease began to be detected in richer countries that more than 40 diagnostic tests suddenly became commercially available to help identify and swiftly tackle the disease.

Altering our planet’s biology

In the last six months there have been over 3,000 confirmed cases of monkeypox across nearly 50 mostly high-income countries. In contrast, with increasing surveillance and waning population immunity since the end of smallpox vaccination in 1980, the number of monkeypox cases and deaths in Africa has been averaging over 2,000 cases and 50-100 deaths every year since 2017.

Multiple factors – from mass vaccination programmes to climate change – are fundamentally altering the biology of our planet. As a result, disease patterns are changing. When Covid-19 was declared a PHEIC, it alerted governments to the need for action, which eventually spurred an unprecedented all-hands-on-deck, global response that was most certainly warranted for a fast-spreading, too-often-lethal pathogen like Sars-CoV-2.

But while full-blown, global pandemics such as Covid-19 remain a threat, frequent smaller but significant outbreaks of new and reemerging diseases are almost certain to be a regular part of life. While we need to take every disease outbreak seriously, it is not practical, feasible or necessary to replicate the Covid-19 response for every outbreak that emerges.

We cannot repetitively put a blanket divert on global resources or send whole swathes of society into lockdown. Research agendas cannot be hijacked and manufacturing lines re-deployed for each new threat.

In short, events like this monkeypox outbreak are the new normal. How will we deal with that reality?

On one hand, the sudden explosion in diagnostic test availability for monkeypox can be seen as a welcome and positive lesson learned from the experience with Covid-19 – the importance of testing to get an emerging disease under control was certainly not widely accepted when Sars-CoV-2 was starting to gain momentum in January 2020.

But on the other, the sudden intense focus on monkeypox only once it circulates in richer areas of the world exposes once again the inequalities in global health. Will we continue to relive these endless cycles of panic-then-forget, which we have seen with Ebola, and are already beginning to see with Covid-19?

Assuming we can bring monkeypox under control in high-income countries, how many of these 40 diagnostic tests, as well as vaccines and therapeutics, will still be available a year from now to control monkeypox in Africa, where they are most needed?

For both ethical and strategic reasons, our only way forward is to accept this new reality of our interconnected world, and to redouble our efforts at disease control in the places where they are endemic.

We need to invest in smarter, integrated and agile tools and approaches that can structurally impact health systems in every country, so that we can nip multiple emerging diseases in the bud before they get out of hand – not wait until they reach high-income regions and populations.

This means a more equitable prioritisation of global disease threats and research and public health programme agendas, as well as creation of manufacturing capacity and stable pipelines for diagnostic tests, vaccines and therapeutics to address needs and ensure access in low- and middle-income countries, all capacitated by appropriate regulatory and ethical frameworks.

Covid-19 showed us that there are no national borders when it comes to outbreaks of infectious diseases. We must level the playing field of public health, so that all countries have flexible, efficient, coordinated disease surveillance systems in place, and every individual has access to reliable tests, vaccines, and therapeutics when and where they need them.

Daniel Bausch is Senior Director, Emerging Threats & Global Health Security, at FIND, the global alliance for diagnostics, as well as President of the American Society of Tropical Medicine and Hygiene and Professor of Tropical Medicine at the London School of Hygiene & Tropical Medicine. He is a Member of the International Health Regulations (IHR) Emergency Committee convened by WHO regarding the multi-country monkeypox outbreak.

Published in The Telegraph, 28 June 2022