The World Health Organization has announced it will hold an emergency meeting with outside experts next Thursday, June 23 to assess whether the monkeypox epidemic is a public health emergency of international concern, the highest alert the WHO can give. Currently, this designation only applies to the ongoing COVID-19 pandemic and to polio.
The number of confirmed and suspected monkeypox infections continues to grow by the day in non-endemic countries around the world, despite the lack of travel links and connections to the clusters known to have been exported from Africa. Many public health experts have urged the World Health Organization (WHO) to act more urgently.
At a press conference on Tuesday, WHO Director-General Tedros Adhanom Ghebreyesus acknowledged that the virus has behaved unpredictably and said that as the number of affected countries grows rapidly, there is a need for international coordination to tackle the epidemic. He commented: “I think it is now clear that there is an unusual situation.”
The cumulative number of cases, including confirmed and suspected cases, reached nearly 1,800 as of June 14, 2022. The seven-day average of new cases (over 80) has risen steadily since the first case was discovered in England on May 6, 2022, in a British citizen returning from Nigeria, where the virus is endemic.
According to a data visualization of monkey pox created by Antonio Caramia, there are 1,688 confirmed cases and 99 suspected. The following 50 countries and territories have confirmed or suspected cases: Argentina, Australia, Austria, Bahamas, Bolivia, Brazil, Canada, Cayman Islands, Czech Republic, Denmark, England, Finland, France, French Guiana, Germany, Ghana, Gibraltar, Greece, Haiti, Hungary, Iceland, Iran, Ireland, Israel, Italy, Kosovo, Latvia, Malta, Mexico, Morocco, Netherlands, Northern Ireland, Norway, Pakistan, Paraguay, Poland, Portugal, Romania, Scotland, Slovenia, Spain, Sudan, Sweden, Switzerland, Uganda, United Arab Emirates, United States, Uruguay, Venezuela and Wales.
England leads the world with the highest number of confirmed cases, with 452. Spain is in second place with 313 confirmed cases and 32 suspected cases. Portugal is third with 209. Germany has 188 confirmed and one suspect. Canada has 123 confirmed and 24 suspected, France 91 confirmed and the United States is in seventh place with 65†
Monkeypox is also endemic in ten countries in West and Central Africa: Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana (identified in animals only), Ivory Coast, Liberia, Nigeria, the Republic of the Congo, and Sierra Leone .
As of January 2022, according to the World Health Organization (WHO), there have been 59 confirmed cases and 1,536 suspected cases, with 72 fatalities, in the WHO’s African region. Of the 1,366 monkeypox infections in the Democratic Republic of Congo, 64 have died. In that country, the more deadly Congo Basin clade dominates, while the less virulent West African clade is currently causing the global outbreak. The death rate associated with the West African clade is said to be about one percent.
While the WHO has not officially recognized any deaths from the current epidemic, there is a recent report from Brazil regarding the possible death from monkey pox of a 41-year-old man who was admitted to Uberlandia Medical Center, a private hospital in Minas Gerais state. The cause of death is currently under investigation. According to local news reports, the infection may have been aggravated by other illnesses.
Director-General Ghebreyesus also announced that an expert working group would propose to change the Monkeypox name, in light of concerns about stigma and racism surrounding the virus that is causing the global epidemic. He said the WHO is “working with partners and experts from around the world to change the name of the monkeypox virus, its clades and the disease it causes.”
The announcement comes on the heels of a pronunciation to the United Nations Health Agency of more than 30 international scientists, declaring an “urgent need for a non-discriminatory and non-stigmatizing nomenclature for monkeypox virus.”
They wrote: “As of June 8, 2022, there were at least 1111 cases of MPXV in humans [monkeypox virus] have been confirmed or suspected, and cases have been discovered in 44 countries. MPXV infection is normally caused by spillover events to humans from animals such as rodents, squirrels and non-human primates. The virus can also be passed from one person to another through close contact with lesions, body fluids, respiratory droplets, and contaminated materials. Case numbers and epidemiological patterns suggest that the current global outbreak is supported by human-to-human transmission.”
The authors added:
The prevailing perception in the international media and scientific literature is that MPXV is endemic to humans in some African countries. However, it is well established that nearly all MPXV outbreaks in Africa prior to the 2022 outbreak were due to animal-to-human transmission, and there have been rare reports of continued human-to-human transmission. In the context of the current global outbreak, the continued reference and nomenclature that this virus is African is not only inaccurate, but also discriminatory and stigmatizing. The most obvious manifestation of this is the use of pictures of African patients to portray the smallpox lesions in the mainstream media in the north of the world. Recently, Foreign Press Association Africa released a statement calling on global media to stop using images of African people to highlight the outbreak in Europe.
While the origins of the new global MPXV outbreak are still unknown, there is mounting evidence that the most likely scenario is that transcontinental, cryptic human transmission has been going on for longer than previously thought. However, there is an increasing narrative in the media and among many scientists trying to link the current global outbreak to Africa or West Africa, or Nigeria. Furthermore, the use of geographic labels for strains of MPXV, especially references to the 2022 outbreak as belonging to the “West African” or “West African” clade, strain or genotype. We therefore believe that a nomenclature that is neutral, non-discriminatory and non-stigmatising will be more appropriate for the global health community.
The authors are correct in suggesting that as the epidemic continues to grow, just as former President Trump had made derogatory and incendiary references to the virus causing COVID by calling it the “China virus” and “Kung flu”, the association of geographic names for diseases and viruses has the capacity to politically weaponize these terms.
Instead, the collaborative working group proposed a new classification based on the order of detection: “MPXV clades 1, 2, and 3.” Clade 1 would correspond to the Congo Basin clade. In contrast, Clades 2 and 3 would correspond to the West African clade. They wrote, “These three clades represent deep MPXV diversity, accumulated over many years of evolution in the animal reservoir. Further sequencing of MPXV from the animal reservoir may reveal further clades 4, 5, 6, and so on.”
In addition, they recommended that the viruses sequenced from samples obtained between 2017 and 2019 from the UK, Israel, Nigeria, the US and Singapore, as well as the 2022 global outbreak, be renamed. “Since viruses in this group have been transmitted from person to person in dozens of countries and possibly over several years, we propose that this represents a transmission route different from that of previous MPXV cases in humans and should be given a separate name so that it can be specifically referred to. can be referenced in both scientific discourse and the general media.”
Even the term “monkeypox” is a misnomer, as the most common animal-to-human crossover occurs through the consumption of infected rodents. But the virus was historically first discovered in macao monkeys brought to a lab in Europe.
Whatever decision the WHO and the emergency committee make in the next two weeks, it is clear that even a declaration of a public health emergency of international concern will be met with nothing more than sensationalism in the media. Vaccine nationalism is in full swing as countries plan to stockpile smallpox vaccines for their citizens. (The smallpox vaccine is quite effective against monkeypox, a related disease).
Scientists and public health experts will push for funding for research, global public surveillance and detecting infectious diseases with pandemic potential and emerging threats. But low-income countries like Africa, where the monkeypox virus poses a much greater threat, will receive little media attention, let alone the necessary resources to support their public health and medical infrastructure.
The current global epidemic of monkeypox infections, such as the COVID pandemic, is essentially not just a public health crisis, but also a crisis of capitalism. The profit system is no better able to mobilize the necessary resources and public health strategy to fight monkeypox than it is to fight SARS-CoV-2. Instead, it diverts crucial funding into the escalation of imperialist wars in Ukraine and elsewhere.
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