Reviews | Monkeypox is spreading rapidly and should be declared a pandemic

Eric Feigl-Ding is an epidemiologist and co-founder of the Global Health Network. Kavita Patel is a medical doctor and former director of policy for the White House Office of Intergovernmental Affairs and Public Engagement. Yaneer Bar-Yam is president of NECSI and co-founder of the Global Health Network.

It’s time for the global public health community to recognize a growing reality: monkeypox is now a pandemic. And unless we declare an emergency and act quickly to combat it, we risk repeating the same mistakes we made in our fight against covid-19.

No longer confined to a single continent or found only among travelers, the monkeypox virus is undergoing community transmission in dozens of countries around the world and is spreading out of control at an alarming rate. This is especially dangerous for the immunocompromised, pregnant women and young children. They all have a much higher rate of hospitalization and death from the virus than healthy adults.

Yet despite the growing number of cases, the World Health Organization has largely downplayed the outbreak. On June 24, the agency failed to declare a public health emergency — just as it repeatedly failed to issue emergency and pandemic statements for the coronavirus, until finally declaring a pandemic in March 2020.

Historically present in West and Central Africa, the monkeypox virus began to spread internationally in early May, when the UK announced its first confirmed positive case. The global reaction since then has been incredibly slow. The number of cases seems low compared to covid-19, and the world seems to be asleep in complacency, like a frog in gradually warming water. Today the virus has spread on more than 70 countries on six continents with no signs of easing. According to the WHO itself, cases have tripled in Europe in the last two weeks. We must realize that we are already in a boiling pot.

The available European data show that most infections have occurred in men who have sex with men (MSM), who are typically young adults. However, cases have been reported among household members, heterosexual contacts and non-sexual contacts, as well as children. About 10 percent of patients were hospitalized for treatment or isolation, and there was an admission to intensive care.

Given the early predominance of cases in the MSM community, many countries are not testing others with symptoms of monkeypox, leading to the risk of skewed infection numbers and wider uncontrolled spread – something that in turn carries a risk of many more people becoming infected with severe cases.

A new study also suggests that the virus could be mutating 12 times faster than expectedand could lead to 60,000 new cases a day in the UK alone by the end of 2022. Other models suggest that we could conceivably see 100,000 cases worldwide by August and 500,000 to 1 million cases by the end of September.

The WHO was created with the vision of coordinating global efforts to promote health and keep the world safe, precisely what we need right now. Healthcare workers and frontline staff are sorely lacking, and the conversation about targeted prevention is insufficient. By failing to sound the alarm preemptively, the WHO is putting countless lives at risk – just as the delay in classifying covid-19 has played a critical role in the failure to effectively control the global explosion of this virus.

We must use the full range of preventive and diagnostic means to halt the spread, prevent the development of local reservoirs of disease in rodents, and prevent suffering and eventual death, especially in immunocompromised people, women pregnant and young children.

Governments and health authorities around the world should alert the public to protective measures and provide support for mitigation, rapid case identification, early diagnosis, contact tracing and isolation. Although a reliable monkeypox vaccine exists thanks to previous research, it will take several months to ramp up production worldwide.

Here in the United States, the federal government has already ordered 1.6 million doses for 800,000 Americans, but those won’t be available until late 2022. By then, it will be too late unless we act now with further containment measures. The Centers for Disease Control and Prevention must lead by example and encourage science-based precautionary measures to protect Americans.

We at Global Health Network have taken steps to issue an early warning. June 22, we have declared monkeypox a pandemic emergency and issued public health guidance on what to do to curb the spread. We invite the WHO to join us and hope that they will reconsider and act soon. WHO Director General Tedros Adhanom Ghebreyesus recently acknowledged the growing threat of monkeypox.

We should all refuse to walk blindly, allowing the present to become the prologue to greater catastrophe. Global health officials must champion and adopt a unified and cohesive approach to combat the monkeypox pandemic before it reaches covid-19 proportions. If we act, guided by the lessons of the past two years, we can avoid the mistakes that are costing the world millions of lives.

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