The Curious Case Of Monkeypox – Is It A World Health Emergency Or Not?

Monkeypox was not designated a pandemic by the WHO (World Health Organisation) on the 23rd of June, in a high-level meeting of International Health Regulations Emergency Committee members, the committee came at a consensus with only a few differing voices and declared that it is is not a Public Health Emergency of International Concern (PHEIC), and thus ruled out the virus as a pandemic.

The Committee further advised that the spread of monkeypox should be vigilantly monitored and the designation of the virus might be reviewed again after 3-4 weeks depending on the nature and the amount of spread, as more information is needed to determine whether the current advice needs reconsideration.

Interestingly a day ahead of the WHO meeting, on 22nd of June, WHN (World Heath Network) an association of doctors had released a statement which declared monkeypox a pandemic, the WHN members had also urged WHO to declare a PHEIC, while highlighting WHO’s late response in declaring the Coronavirus as PHEIC in early January 2020, and warned that the lessons of history should not be repeated.

The statement of the WHN drew a lot of media attention and was widely picked up by the Indian media as well, which created a sense of media pressure on the WHO to declare monkeypox a pandemic a day after.

“One should not compare the WHN with WHO by any standards, and the statement they issued is just their opinion and people are allowed to have their opinion but that has nothing to do with the world health. I was surprised to see the Indian media quoting their name and not counter checking what the WHN really stands for its just a collective of doctors and it cannot dictate or pressure the WHO to declare a pandemic, WHO is a legitimate body that has decades of experience of combating multiple diseases on the ground across all continents,” stated Dr Rajeev Jayadevan, Co-chairman of the Indian Medical Association’s Covid-19 National Task Force.

Dr Rajeev further explains that in order for WHO to declare monkeypox a PHEIC, it has to be serious, sudden and unusual, and it must necessitate immediate international action, in other words an extraordinary event that endangers the public health. He says though the monkeypox virus deserves due attention and should be monitored but majorly the virus is just another infectious disease among dozens of other infectious diseases that the doctors treat on a regular basis. He further adds that the virus has mainly spread in men who have sex with men in the focus networks of LGBTQI community and its festivals that happened in Europe.

What Do We Know So far?

According to CDC (Centre For Disease Control) globally there are about 4769 confirmed monkeypox cases in close to 49 countries as of 28 June 2022, with European Countries reporting the majority of the cases followed by the US. The Virus has reached Southeast Asia, as one case has been detected in Singapore, but no case has been reported in India so far. 

The disease is being reported in non-endemic countries, the early cases reported in these countries had no epidemiological links to areas which have historically reported monkeypox, hinting that the undetected spread might have been going on in these countries for some time.  

The WHO highlighted that the clinical presentation in the patients is often atypical with few lesions on genitals, or on peri-oral area that do not spread further, and an asynchronous rash that presents itself prior to other symptoms like fever, lymphadenopathy and malaise.

There have been only a few hospitalisations, and only one person has died due the current monkeypox spread. The spread has been largely seen among the LGBQTI community as the reproduction number of the virus in men who have sex with men was also seen greater than 1 as opposed to the average number which is 0.8. The mean incubation period is suggested to be at 8.5 days for the zoonotic virus.

Enumerating on the pace of the spread, Dr Jayadevan said that the monkeypox virus is not spreading fast and it's only appearing mainly among men, and women and children are not majorly getting affected by it, “if you take the 300 cases in France only one was female, out of the 759 cases in UK only 5 were women, any public health emergency would have more or less equal proportion of people affected among different gender, and if you look at the hospitalisation data in Spain out of the first 736 detected  monkeypox cases only 20 were in the hospital”, he added. 

The monkeypox virus can be transmitted from skin to skin contact to face to face contact via respiratory droplets, or even contaminated surfaces or material, one can exercise precaution by avoiding close contact of any kind with people who show symptoms of the monkeypox virus. 

“The transmission pattern of Monkeypox has evolved. This could be due to the mutations in the virus that may have been ongoing since the past few years. While this zoonotic disease continues to spread from animals to humans, there is an increasing human-to-human transmission being seen. The classic clinical picture of a prodromal illness characterised by fever and followed by a rash that progresses to pustules has changed. Today, the illness can begin with a swelling of the lymph nodes and progress to a rash that starts in the genital area but does not spread to all parts of the body. The pus-filled lesions are still being seen though,” stated Dr Vikram Vora, Medical Director, India Subcontinent - International SOS.

Is India Ready For A Monkeypox Outbreak

Although there are no monkeypox cases in India so far Dr Vora explains it’s not a matter of If a case is detected rather than, When the first case will be detected in India. He said that the Health Ministry has already begun their preparations, as the ministry published guidelines to manage monkeypox on 31st May 2022, consequently many states have readied isolation wards in infectious diseases hospitals for any eventuality. “The National Institute of Virology has been tasked with testing any samples that may be sent to it. On a larger scale, thermal cameras at airports and seaports have also been proposed for surveillance and early detection so that testing, contact tracing and containment through isolation can occur,” he added.

Speaking about the precautions that one must take to avoid catching the virus Dr Vora explained that the most important precaution that one requires is being correctly informed. He warned that the Covid-19 infodemic should not repeat itself. “During travel, one is advised to refrain from touching animals and consuming exotic game meat. Avoid contact with people who may appear sick and if you suspect yourself to be ill, then isolate for a few days. This isolation is especially important if you have returned from a country that has active monkeypox cases,” he further added.

Monkeypox in most cases is a self-limited disease with symptoms that last from 2 to 4 weeks, which rarely requires hospitalisation, though severe cases may occur. There is no cure for monkeypox virus till now but the smallpox virus vaccine is effective with an 85 per cent efficacy against the monkeypox virus.

WHO has also informed that a lot is still to be known of the monkeypox virus as there is need to address the knowledge gaps that exist in modes of transmission of the virus, infectious period, reservoir species, potential for reverse zoonoses, and access to vaccines, antivirals and their efficacy in people.