Monkeypox is an old acquaintance in Africa, particularly in the central and western regions, where it causes thousands of cases and dozens of deaths every year. In fact, outbreaks have increased over the past two decades due to factors such as the cessation of smallpox vaccination starting in 1980, which led to cross-immunity, as well as deforestation and demographic pressures in tropical forest areas that host multiple species of squirrels and rodents, could be the natural hosts of the virus according to the latest findings. For this reason, and because of the growing risk of contagion outside of Africa, scientists have long warned of the need to allocate more funding to research, prevention and vaccination.
“Not enough has been done. We continue to have very limited knowledge of the various aspects of the disease and until contagion occurs in the Global North, this virus will not receive the attention it deserves. We are more reactive than proactive,” says Nikola Sklenovská, an epidemiologist specializing in monkeypox. The virus was first identified in a population of monkeys at the Copenhagen State Serological Institute in 1958, hence the name of the disease, which had been brought to Europe from various African countries to be used as guinea pigs in vaccine development Polio. Years later, another outbreak erupted in US zoos, affecting primates, antelope and rodents. Primates are considered adventitious hosts and not the main reservoir of the virus.
However, it was not until 1970 that the first human case was discovered in the Democratic Republic of the Congo (DRC). Only 45 cases were recorded over the next 10 years, almost all in the lush Congolese rainforest, as well as in Liberia and Sierra Leone. In fact, the disease was very sporadic until the early 2000s, when there was a change in pattern and an increase in outbreaks. “Currently we have about 2,000 cases each year in the Democratic Republic of the Congo and the trend is increasing, although with the current information it is difficult to know whether this is due to environmental causes or whether efforts have been made to detect it,” says Sklenovská.
The first fear in Western countries came in 2003 with an outbreak in the United States in which about 70 people were infected by rodents from Ghana that had become fashionable as pets. In Europe, the first three infected people were identified in 2018, particularly in the UK. Two of them were people who had been to Nigeria, where an epidemic caused 400 confirmed and suspected cases that same year.
During one of the outbreaks in Congo, Katy Brown, a nurse and health advisor at Médecins Sans Frontières (MSF) emergency department, was caring for a five-year-old boy suffering from the disease. “Because of the rash in his mouth, it was difficult for him to eat and drink, so hydration and nutritional support were very important, as was infection prevention and control,” he says. In fact, most deaths in Africa are caused by blood poisoning resulting from wounds caused by the virus, particularly on the skin of the face, trunk and extremities. “It was a scary time for the boy and his father, we both had to isolate and they needed a lot of support,” Brown recalls.
There are two known variants of monkeypox, one common in Central Africa and more virulent, with a childhood mortality that can reach 10%, although it has fallen to 6% in recent outbreaks, and another in West Africa that is thought to be milder, because it causes only 1% of deaths on average. The WHO defines it as “a rare viral zoonosis occurring mainly in remote parts of central and west Africa near tropical forests”. However, this definition has become outdated as cases have become more common and also in more urban settings.
“There are two vaccines,” explains Miriam Alía, director of immunizations and emergency response at MSF, “one approved by the US Food and Drug Administration and one approved by the European Medicines Agency,” she says. “The problem is that only a few are produced and it is difficult for many African countries to get hold of the doses.” Immunization against monkeypox is not massive, but in rings: Contact persons of infected people are vaccinated, as is the case with Ebola is. The smallpox vaccine offered up to 85% protection, but it has not been given since the disease was eradicated in 1980, after the spread of the virus,” Sklenovská recalls.
Scientists have been warning of the recurrence of this disease for years. In 2017, in an interview with EL PAÍS, the biologist Anne Laudisoit recalled the threat posed by this virus, particularly in Africa but also for the rest of the world, warning with a tone of frustration: “As long as there is no target with monkeypox, the pustules and rash looks like smallpox, everything stays the same. Brown believes that “relieving the suffering caused by monkeypox and other neglected tropical diseases must be taken seriously, wherever they are in the world; It is reprehensible that certain diseases only deserve attention when they affect high-income countries.”