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Monkeypox: a warning that has been ignored for years

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Monkeypox: a warning that has been ignored for years

While the Western world marveled at the “sudden” emergence of monkeypox outbreaks, African epidemiologists were grappling with a terrible déjà vu. This viral disease (monkeypox, in English) has been present in Central and West Africa for decades, and for some time local scientists have pointed out the potential for spread of the virus, whose behavior has changed since the beginning. But if the response to the infections recently recorded in Spain, Canada, the USA and the United Kingdom has been timely, the same cannot be said for the resources deployed in Africa, where an even more lethal strain of the virus circulates.

Two weights, two measures. Monkeypox was ignored by Western countries until it touched them closely. And now that we are all in the same boat, the treatment given to patients and close contacts in different countries is by no means fair. Prior to this year, the spread of monkeypox outside Africa had been barely noticeable: the most important outbreak occurred in the US in 2003, but only about seventy were infected.

The cases outside Africa mostly involved people returning from the continent or coming into contact with imported animals: although it is not clear which species are natural reserves of the virus – the pathogen is so called because it was first observed in some laboratory primates in 1958 – however, it is known that it circulates in rodents, which can transmit it to humans.

More dangerous. As explained on Nature, some African countries have been struggling with monkeypox since 1970, when the first case of human infection was identified in Congo. A major outbreak broke out in Nigeria in 2017, with over 200 confirmed cases and 500 suspects. In the last ten years, thousands of probable cases, and hundreds of suspected deaths attributable to the virus have occurred in the Democratic Republic of the Congo: the strain of monkeypox circulating in central Africa is moreover more virulent and more lethal, with a mortality of 10 %.

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A curious evolution. Scientists in Africa who have studied these latest outbreaks have noticed something strange. Before 2017, monkeypox circulated mainly in the countryside, among hunters who came into contact with infected animals. It usually presented with fever and the characteristic fluid-filled pustules on the hands, feet and face.

After that year, however, it began to appear in cities, and lesions also appeared in the genital areas, indicating a sexual infection or through intimate contact between humans. The same guise that the virus now has in the West: if the alarm raised five years ago in Africa had been heeded, we would not be so surprised today.

More vulnerable. Another long-ignored observation concerns the reduced immunity to the virus due to a breakthrough in modern medicine, namely the eradication of smallpox (a virus related to that of monkeypox, but more lethal) in 1980 and the consequent stop to vaccinations. against it. The new generations are therefore more vulnerable to monkeypox and cases in sub-Saharan Africa have been increasing for decades.

We haven’t learned anything. At the same time, countries where the threat was much less concrete than in Africa have amassed stocks of smallpox vaccines in the remote possibility of the virus escaping from laboratories or of their use as biological weapons. Now those stocks are used in France, the United Kingdom, Canada and the United States for a ring vaccination strategy, which consists of administering the vaccine to all close contacts of the infected.

An approach that Africa would also have adopted, if only there were enough vaccines available. But Western countries did not donate their supplies to African ones who needed them, not even to protect frontline health workers. If it reminds you of something, it’s because history repeats itself: the same thing happened with CoViD-19.

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Not just vaccines. The WHO has 31 million doses of the smallpox vaccine donated by member countries, but these are first generation vaccines, with several side effects and not recommended against monkeypox, which is much less lethal. And even if there were supplies for everyone, vaccines alone would not win the challenge.

In order not to consume them empty, it is first of all necessary to improve surveillance and diagnosis against the disease. Ring vaccination is only effective if you understand how the pathogen is circulating locally. It is also necessary to understand from which animals the virus originates and to intervene At the sourcethat is, on the close contact between man and wildlife.

Above all, it is necessary to act uniformly. Isolated solutions, which solve the problem only in industrialized countries, will soon present the bill elsewhere, and then again here, in the cycles and recycles that we have now come to know.

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