Alfred Dawes | Monkeypox is no joke

Put away your COVID-19 decorations, it’s monkeypox season! Despite the jokes made in poor taste, and the memes that are actually funny, monkeypox is no joke – it has been around for decades. It was over 40 years ago when it was first identified in humans, after previously being described in monkeys; hence the name. The disease is endemic in parts of central and western Africa, where outbreaks occur sporadically. Fortunately, not many people have succumbed to the disease in these outbreaks, and we have always been fortunate to see limited spread.

This is primarily because monkeypox is not as transmissible as airborne and aerosol spread diseases such as COVID-19, influenza, and chickenpox. The disease is primarily spread by close contact or contaminated surfaces. Monkeypox is generally a mild disease with a predictable, self-limiting course of a few weeks.

Although scientists have been warning for quite some time that we are susceptible to a monkeypox pandemic, very little has been done to inform the world of this disease. Nor have steps been taken to fast-track the production of vaccines that are already proven to protect against infections. Instead, only smallpox vaccines have been used to treat and offer some degree of protection against monkeypox in vulnerable populations in Africa. As it belongs to a similar family of viruses, the smallpox vaccine offers approximately 70 per cent protection against developing monkeypox. Unfortunately, nobody born after 1979 has been a part of any smallpox vaccination programme. Millennials and younger people are at the greatest risk of contracting these diseases.

It is only been since the spread of the disease to other countries in Western Europe and North America have we really seen concerted efforts made to deploy monkeypox vaccines. Many African countries are now asking where was this vaccine all along when they were battling their own outbreaks.

Monkeypox is far from as deadly as smallpox. The latter has been responsible for the decimation of entire civilisations. In fact, the colonisation of the New World would not have been possible had it not been for smallpox epidemics brought over by the Spanish conquistadors. The conquests of the Aztec and Mayan civilisations, as well as the Mississippi River societies, were as a result of smallpox depopulating their cities, wiping out more than half to, by some estimates, 90 per cent of the population in these areas. This paved the way for the colonists to move in practically unchallenged.

NOT AS CONTAGIOUS

Monkeypox, on the other hand, has a case fatality rate of anywhere between one and 10 per cent. It is mostly serious in persons suffering from comorbidities that render their immune systems susceptible to severe infections. As it is not as contagious or as deadly, this disease does not deserve the hysteria that is being created around its emergence in multiple countries for the first time. We must, however, be cognisant of the fact that it can mutate into a more serious form, leading to greater transmissibility and loss of life. As such, we need to quit monkeying around with the public education and sensationalism surrounding this latest outbreak.

The circumstances surrounding the escape of Jamaica’s patient zero from the May Pen Hospital remain shrouded in mystery. Did he saunter out of the hospital unopposed, or did he climb through a window to make his escape? The reports from the hospital and the patient’s own accounts are quite different. What we do know is that the taxi driver who drove the getaway car still remains at large. We do not know if he has now developed the disease and is spreading it to others in close contact with him. Indeed, if a public passenger vehicle is being driven by someone who is contagious, then he alone could be the superspreader who results in the disease spreading far beyond identified contacts of patient zero.

It is uncomfortable to speak of the circumstances surrounding the explosion in the spread of monkeypox in this outbreak. Usually spread outside of central and western Africa has been linked to the importation of animals or travel to African countries where the disease is endemic. This time around, it is said to be linked to two rave parties where orgies involving gay men from different countries led to the widespread dissemination of the disease from these superspreader events. Although it is not a sexually transmitted disease, monkeypox can be spread through sexual intercourse because of the close contact with skin lesions.

This initial intercontinental spread by gay men is almost a taboo topic because of the ramifications of identifying the disease with homosexuality. It is still fresh in the memories of many that AIDS was initially called Gay Related Immunodeficiency. The stigmatisation that occurred as a rest of this nomenclature severely hampered the concerted efforts to manage the disease that also appeared in intravenous drug users and heterosexual couples. We are also very much aware that the suppression of information feeds into the assembly line of conspiracy theories.

Public education is needed urgently. Not sensationalism, not hysteria, just straight facts. Otherwise we should all buckle up and expect another real-life manifestation of the all-too-real film Don’t Look Up. Whenever politics, money and the need for one-upmanship get a hold of science, we end up debating gravity and whether the earth is flat. When human lives are at stake, we cannot joke about this.

Dr Alfred Dawes is a fellow of the American College of Surgeons, CEO of Windsor Wellness Centre. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and adawes@ilapmedical.com.