WHO’s Regional Director for Europe, Hans Kluge, has asked the 53 countries in the WHO region to “act with urgency” in halting the Monkeypox emergency that has hit the region hardest  – noting that “vaccines alone won’t end the outbreak”. 

Kluge’s statement Tuesday followed Saturday’s declaration by WHO of a global public health emergency over the spread of the virus, which has now infected over 18,000 people in 78 countries, according to Tuesday’s data. That is not including several thousand more suspected cases in areas of central and west Africa where the animal-borne disease is endemic, but testing capacity is low.  

Among those, some 81 children under the age of 17 have been reported with infections around the world, said WHO’s Rosamund Lewis, speaking at another press briefing in Geneva. 

“We do still believe that this outbreak of monkeypox can be stopped, with the right strategies in the right groups,” Lewis said at a briefing. “But time is going by and we all need to pull together.”

Europe has been the epicenter of the recent outbreak, with 37 countries affected so far and the public health risk in the region described as “high”, Kluge said: 

“From 13 May through 22 July, close to 12 000 probable or confirmed cases, mostly in men who have sex with men, have been reported in the Region, of whom 8% were hospitalized with, fortunately, no deaths to date.”  WHO’s dashboard put the number of cases in the European region at 13,000.  

Remove health care barriers, confront stigmatization, limit sexual partners 

Kluge called upon health providers to “remove any and all barriers” for patients to access care, as well as battle stigmatization.

“Any barrier, however large or small, will act to prevent patients from coming forward,” Kluge stressed, adding that healthcare providers also need to watch out for “atypical” presentations of the virus, marked by skin lesions, that can mimic others disease as well as removing “any judgment or stigma from the patient pathway – the lessons of HIV/AIDS must not be forgotten. 

Limit sexual partners, for time being at least

But he also called upon men who have sex with men – who are in the highest risk groups to “consider limiting your sexual partners and interactions at this time.” 

“This may be a tough message, but exercising caution can safeguard you and your wider community. While vaccination may be available to some people with higher exposure risks, it is not a silver bullet, and we still ask you to take steps to lower that risk for the time being,” said Kluge in the statement. 

Public health authorities – boost national capacities & collaborate regionally  

Meanwhile, Kluge called upon national public health authorities to “significantly and swiftly boost national capacities for monkeypox surveillance, investigation, diagnostics and contact tracing to help identify and track every possible case. Many cases are likely going undetected, further fuelling the outbreak.  

He also admonished policymakers to “Genuinely work together with at-risk groups and communities and their leaders – including organizers of community events such as summertime Pride festivities – to develop and disseminate crucial messages aimed at curtailing transmission and encouraging uptake of health services.”

There is a “burning need for cross-regional collaboration” he added, calling upon countries to  “ensure vaccines and antivirals reach those who need them the most, as opposed to stockpiling supplies and “going it alone” – actions that are only detrimental to the wider public good, as we’ve seen during the response to COVID-19.” 

Testing capacity low in central Africa where several thousand cases suspected

But there are major holes in testing capacity – in the very countries that have traditionally been endemic for the disease. 

For instance, in the entire WHO African region, where 12 central and eastern African countries are endemic for the disease, only 328 cases have been confirmed by WHO -although Africa is the only region having reported deaths from Monkeypox – five in total.  

In countries such as the Democratic Republic of the Congo, DRC, it over 2000 suspected cases have been reported since the start of the year WHO’s Afrian Region has reported.  But only 163 cases have been confirmed.  

That is largely a reflection of the severe limitation of testing in Africa, and other low- and middle-income regions, which require more WHO support, Lewis said. The WHO global dashboard does not include suspected cases.

This morning, at @MinofHealthUG, @WHO donated PCR kits to test over 2,400 samples for #Monkeypox in #Uganda. A good step in preventing the disease in the country after Monkeypox was declared a Public Health Emergency of International Concern on July 23, 2022. pic.twitter.com/vV6P1pCSt4

— WHO Uganda (@WHOUganda) July 26, 2022

Traditionally, the clade of monkeypox circulating in DRC and elsewhere in Central Africa has been much more deadly than west African clade, which had seen an upswing in cases in countries such as Nigeria in recent years. A variant of the milder clade was likely transmitted to via international travel to Europe, where person-to-person transmission became more intense and more sustained, triggering the current outbreak.   

Meanwhile, the Americas is the second most heavily-affected region, with some 4,600 cases, with the United States and Brazil most heavily affected. Only 61 cases and 25 have been reported in the WHO’s Western Pacific and Eastern Mediterranean regions respectively. WHO’s South East Asian Regional Office has reported only 5 cases. 

Some 16.4 million vaccines available in bulk, but need to be “filled and finished”

As for vaccines, WHO officials have said that some 16.4 million doses of the most effective vaccines  (MVA-BN) are currently available in bulk.  However only about 1 million have been processed into the “fill and finish” of vials ready for delivery. 

Lewis said that the WHO was working with Member States and the European Union on strategies for releasing monkeypox vaccines – along with the creation of a global coordination mechanism. A dashboard with regularly updated data on cases has also been created online.

In combatting monkeypox, mass vaccination is not required, she said, but rather targeted vaccination of health workers, men at high risk because they have had multiple sex partners, and family members of other infected people.  WHO also has recommended post-exposure vaccination of contacts.

Targeted vaccination strategies recommended

Historically smallpox vaccines have been very effective against monkeypox. However, the so-called ‘third’ generation vaccines have remain somewhat untested due to their lack of widespread deployment, and “because they are more attenuated, it is possible they are less effective” against the monkeypox virus, she said. 

The third generation vaccine MVA-BN vaccine, produced by Bavarian Nordic, is the vaccine currently is the most demand. It is regarded as the safest because the vaccinia virus injected does not replicate inside the body. 

MVA-BN is being produced in Denmark and the United States, under the trade names of JYNNEOS and Imvanex, with about 16.4 million doses available in bulk but only about 1 million doses readily available for distribution in a “fill and finish” state, according to WHO’s Tim Nguyen, speaking at Saturday’s press briefing. 

Japan produces another third generation smallpox/monkeypox vaccine, LC-16 but it has not offered to share it beyond its national stockpiles.   A large global stockpile exists of the second generation ACAM2000® vaccine, which was seen to be highly effective against monkeypox when used in smallpox eradication campaigns that ended in the 1970s.  But it has more side effects and is therefore not in high demand presently. 

Lewis called upon countries and manufacturers with vaccines or therapeutics manufacturing capacity to “increase production, and increased availability and … to work with WHO to ensure that diagnostics, vaccines, therapeutics and other necessary supplies are made available based on public health needs, human rights, solidarity and at reasonable cost to countries that most need them to stop the monkeypox outbreak.”  

Image Credits: ET Times Lifestyle/Twitter, WHO.