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Absence of vaccine heightens fear of monkeypox

By Chukwuma Muanya (Deputy Editor)
12 August 2022   |   4:20 am
Two weeks after Brazil, India and Spain recorded their first monkeypox deaths days after the World Health Organisation (WHO) declared the monkeypox outbreak a global health emergency...

Test tubes labelled “Monkeypox virus positive” are seen in this illustration taken May 23, 2022. REUTERS/Dado Ruvic/Illustration

• Nigeria confirms 24 new cases, four deaths
• Nigerian deported from Cambodia after recovering from virus
• Be ready for monkeypox outbreak in villages, FG tells health officers
• Africa CDC, WHO experts lament vaccine, global health inequality
• New virus discovered, infects dozens in China three years after COVID-19
• U.S. supports Nigeria’s disease surveillance, response efforts
• Increased outbreaks highlight gaps in actual disease burden in Africa, animal reservoirs, say researchers

Two weeks after Brazil, India and Spain recorded their first monkeypox deaths days after the World Health Organisation (WHO) declared the monkeypox outbreak a global health emergency, concerns over further spread of the virus and increase in global fatality have heightened.

Consequently, WHO urged countries to work more together to stop the rapidly spreading outbreak, “no matter the nationality, skin colour or religion of the affected population.”

So far, nearly 100 people have died of monkeypox this year. Two in Spain, one in India, one in Brazil. The remaining victims, which is likely an undercount, have all died in central and western Africa, where the disease has been endemic for many decades. In all, the global monkeypox outbreak has seen more than 26,000 cases in nearly 90 countries since May.

A Nigerian resident in Cambodia, Osmond Chihazirim Nzerem, was deported after recovery from monkeypox virus, Cambodian immigration officials said this week. Nzerem, 27, was also banned from re-entering the country for three years.

He was said to have previously fled from neighbouring Thailand despite a positive test result for the disease. He was later arrested by Cambodian authorities in the capital, Phnom Penh, on July 23 and sent to the Khmer-Soviet Friendship Hospital for treatment.

Nzerem, who recovered, was discharged from the hospital on Saturday and deported on Tuesday. He is reportedly the first and only imported monkeypox case in the Southeast Asian country.

Already, the Federal Government has urged Community Health Officers (CHO) to be prepared for the outbreak in villages. The Minister of State for Health, Ekumankama Nkama, gave the charge during the induction of 477 CHOs by the Community Health Practitioners Registration Board of Nigeria in Abuja.

According to the Minister, the outbreak of monkeypox and other diseases have made it important for the country’s health sector to be ready to track any possible challenges. He noted that CMOs, being among the first responders because they are closer to the people, must do so appropriately.

GIVING update on the virus, the Director General, Nigeria Centre for Disease Control (NCDC), Dr. Ifedayo Adetifa, said: “We have confirmed 157 cases since January 1, 2022. This means that we recorded 24 new cases in one week, from 133 cases with four casualties also recorded.

“We don’t have monkeypox vaccines yet. We have made request and we have received response. We hope to get the monkeypox vaccines soon.

“We are still in outbreak respond mode in Nigeria. We are strengthening surveillance so that we can get more cases. We are ramping up all efforts towards containing the situation and so that we can get full sense of the burden of the disease. There is still a bit of under reporting of cases in Nigeria. Some people are confusing monkeypox with chickenpox.”

Only weeks after cases of monkeypox were detected outside of Africa, vaccination campaigns have begun in Western countries, as they have started inoculating at-risk populations with smallpox vaccines that protect against monkeypox.

Yet, despite thousands of cases since monkeypox emerged in Africa in 1970, and hundreds of deaths, not a single vaccination campaign has been set up on the continent. This explains why the world is now dealing with yet another global health emergency.

Despite these few deaths last month and signs that it would spread further, Africa is fighting monkeypox without vaccine just as it did with COVID-19.

A surge in monkeypox infections has particularly been reported since early May in the West and Central African countries where the disease has long been endemic.

Africa remains the only part of the world with no doses of the vaccine, according to the Africa Centre for Disease Control and Prevention (Africa CDC).

“Let us get vaccines on to the continent,” acting head of Africa CDC, Ahmed Ogwell, said in a weekly media briefing last week, pointing to another instance of 1.3 billion people on the continent without access to a vaccine.

Ogwell said Africa CDC has engaged with international partners in attempts to obtain vaccines, and while he said “good news” is expected in the coming days, “we cannot give you a timeline.”

Even doses of the smallpox vaccine, which has shown effectiveness against monkeypox, are not available in Africa, Ogwell said.

“The solutions need to be global in nature,” he said, in a warning to the international community. “If we’re not safe, the rest of the world is not safe.”

The COVID-19 pandemic and the global hoarding of vaccine doses were a jolt to African leaders, who quickly joined together in an unprecedented effort to obtain doses and establish the production of more vaccines on the continent.

Also, speaking from Dakar, Senegal, WHO Assistant Director-General for Emergencies, Ibrahima Soce Fall, said: “We have been working on monkeypox in Africa for several years, but nobody was interested.”

Once referred to as a “neglected tropical disease,” he said that WHO had been working on monkeypox with very few resources. However, once Western countries began getting affected by the disease “the world reacted. It was the same with the Zika virus and we have to stop this discrimination,” Fall said.

On July 23, the WHO declared the spread of the virus to be a public health emergency of international concern – the organisation’s highest level of alert. In this way, WHO aims to enhance coordination, the cooperation of nations, and global solidarity.

“The world must be involved to protect these populations, no matter their nationality, their skin colour, or their religion,” Fall said.

“I think it is extremely important and now that more than 70 countries are affected in the world, everyone is getting active.”

Although a vaccine to prevent monkeypox was approved in 2019, availability remains limited at the moment.

“We have had many cases in the Democratic Republic of Congo, Nigeria, Central African Republic, Cameroun, and some sporadic cases in countries such as Ghana, Benin etc.,” Fall said.

“I think it is time that the world invests so that these populations that are living in rural areas and in forest areas, can be protected.”

According to Fall, “if we only treat what is happening in Europe and America, we will only treat the symptoms of monkeypox, but not the real disease. It is important that the world gets mobilised to this kind of disease.”

Until this year, the virus that causes monkeypox had rarely spread outside Africa, where it is endemic. The spread of monkeypox outside Africa isn’t likely to stop, showing once again that eradicating infectious diseases in countries far away from home isn’t so much a matter of solidarity—but of self-preservation.

“I don’t expect rich nations to do anything different with monkeypox. They will do exactly what they did with COVID-19; corner the vaccine supplies, hoard them, and block vaccine manufacturing in low- and middle-income countries,” said Madhukar Pai, director of McGill University’s global health programs.

“And just like we are seeing no end to COVID-19, monkeypox will be kept alive and well because of the myopia and greed of rich nations.”

MEANWHILE, scientists in Asia have identified a new virus that can cause severe fever and likely transmitted to humans from animals in China. The Langya henipavirus (LayV) was found in 35 people in the Shandong and Henan provinces of China.

The virus can cause acute fever, fatigue, cough and loss of appetite, researchers said in the letter published in the New England Journal of Medicine this month. Some patients also had body aches, nausea, vomiting and headaches, it said. Several also had impaired liver function.

The researchers, who are based in China, Australia and Singapore, said LayV was first identified in a 53-year-old woman in December 2018 during surveillance of patients who had an acute fever and recent history of exposure to animals.

The researchers then conducted surveys of domestic and wild animals to track down the animal host of the virus, and found Langya RNA was most predominant in shrews, small mammals with a long snout and tiny eyes.

Some 27 per cent of shrews tested positive for the virus, suggesting the animals may be “a natural reservoir of LayV”, they wrote. Some five per cent of dogs and two per cent of goats also tested positive, they said.

The discovery of LayV comes less than three years into the COVID-19 pandemic, which scientists believe was also caused by virus spillovers from animals to humans.

But unlike SARS-CoV2, the virus that causes COVID-19, the researchers behind the new study said they had found no evidence of human-to-human transmission for LayV so far.

“There was no close contact or common exposure history among the patients, which suggests that the infection in the human population may be sporadic,” they wrote.

YESTERDAY, the U.S. Consul General, Will Stevens, joined senior public health officials in the country to commission an upgraded biorepository laboratory at the NCDC’s Central Public Health Laboratory in Yaba, Lagos.
The expansion and equipping of the biorepository were supported by the U.S. Centers for Disease Control and Prevention (U.S. CDC) through COVID-19 CARES Act funding.
In addition to the provision of equipment and medical supplies, the U.S. CDC supported the training of NCDC staff to improve local capacity in managing the laboratory. 

In his remarks, Consul General Stevens noted that the new facility will support Nigeria’s disease control efforts through the cataloguing and storing of blood samples for future use, such as testing to improve the detection and surveillance of new, emerging, and reemerging diseases. 
He expressed optimism that the upgraded biorepository laboratory will support Nigeria’s readiness for future epidemic and pandemic responses. 
“Today’s commissioning is a major accomplishment of the strategic partnership between the United States and Nigeria to support health security and respond to disease threats,” Consul General Stevens said.
Consul General Stevens highlighted the U.S-Nigeria longstanding partnership with Nigerian health institutions to implement key public health programs, evaluate disease surveillance and response efforts, and contribute to reinforcing the existing public health infrastructure.