As the World Health Organization calculates whether to declare monkeypox a global health emergency, infectious disease experts are urging health officials to be more proactive and start ramping up vaccinations and surveillance — especially in African nations where the virus is most prevalent.
The WHO convened its emergency committee Thursday to consider whether the spiralling outbreak of monkeypox should be declared a “public health emergency of international concern,” the WHO’s highest level of alert.
But the United Nations agency is facing criticism over its treatment of monkeypox — jumping into action only after the disease started to spread in rich western nations.
The viral disease that causes flu-like symptoms and skin lesions is endemic in parts of Africa, which means it is consistently present in certain regions. The continent has registered just over 1,500 suspected cases since the start of 2022, of which 70 have been fatal, according to the WHO.
By comparison, Canada has confirmed over 200 cases, the majority of which are in Quebec, and has had no deaths.
“There are more cases that occur in Africa on a yearly basis than have already been reported outside of Africa right now. And there are more deaths that have occurred in Africa from monkeypox than have occurred in the rest of the world,” said Dr. Sameer Elsayed, an infectious disease physician and professor of epidemiology and biostatistics at Western University.
That’s why he believes Africa should be getting the lion’s share of resources to deal with monkeypox — and that should include mass vaccinations, he says.
“I think Africa needs to be looked at with high, high priority,” he said.
“It needs to be a mass vaccination campaign for monkeypox with the newer vaccines for people in the African continent, especially in the high endemic areas.”
He’s not alone.
Dr. Monica Gandhi, a physician and infectious disease expert at the University of California, San Francisco, says she also believes more people living in regions where monkeypox is more prevalent should be vaccinated.
“That will actually stop it in endemic regions in this non-endemic outbreak.”
That the WHO is only now taking monkeypox seriously is “profoundly problematic,” Gandhi says, given that the disease has been spreading and killing people in Central and West Africa for years.
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“It’s been circulating since 1958. There are increasing outbreaks — a severe one in Nigeria, for example in 2017 — and it’s only really essentially when this has affected high-income countries that the WHO is jumping on it.”
Experts who have worked on monkeypox in places like the Democratic Republic of Congo have long taken note of rising cases while population immunity to pox viruses has been decreasing, due to lack of vaccination. This is why the world shouldn’t be surprised at the current outbreaks, said Anne Rimoin, an epidemiology professor at UCLA in California, who has studied monkeypox for two decades.
The COVID-19 pandemic has demonstrated how quickly a deadly virus can spread across the globe when the right conditions are present, so health officials ought to learn from this and start being more proactive, she said.
“When it comes to infectious diseases, in particular those viruses that have the potential for global spread, it’s much easier to stay out of trouble than it is to have to get out of trouble.”
In addition to providing vaccines, health officials should also be ramping up resources to study this disease and do more surveillance to get a better understanding of monkeypox and learn why it is spreading in new and unusual ways, Rimoin said.
“We’ve given this virus a lot of runway to be able to spread. We have not been looking for it as vigilantly as we should be,” she said.
“I think we have to learn the lessons that we’ve learned with COVID-19 and that it is much better to invest ahead of time to get in front of these viruses, to do the kind of surveillance it’s necessary to be regularly updating our knowledge about viruses.”
Good disease surveillance is just as important in poorer countries as it is in “high-resource settings,” she added.
Like many countries around the world, Canada and the United States stopped vaccinating the general population against smallpox by around 1972, which means many on this continent are highly susceptible to pox viruses like monkeypox.
Given that scientists expect to see more emerging infectious diseases due to factors such as climate change, deforestation and globalization, the world should start getting better prepared for new outbreaks, Elsayed said.
This is why, in addition to calling for vaccinations and more resources to fight monkeypox in Africa, Elsayed believes governments in developed nations should also consider more options to protect citizens from pox viruses, including possibly re-introducing mass smallpox vaccinations.
“I believe that these vaccines should come on board again for the general population … but not (just) for monkeypox, but also to protect the world against perhaps a smallpox pandemic that can happen in the future, or even another virus that’s closely related to monkeypox but hasn’t reached humans,” Elsayed said.
He stressed this should only be considered after addressing the more pressing needs in Africa first.
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Rimoin noted that when the world stopped vaccinating against smallpox, it opened a “gap of immunity” for populations to once again be vulnerable to it. And with the emergence of a number of new pox viruses in different parts of the globe, including mousepox, cowpox and camelpox, the world is not immune to new outbreaks, she said.
“We now have to really think about, How important is it for us to be able to keep pox viruses out of the population?” she said. “What are the stakes of allowing this virus to spread? And then acting accordingly.”
-With files from Global News reporter Reggie Checcini and Reuters.
VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.
Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.
In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.
The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.
Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”
Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”
This report by The Canadian Press was first published Sept. 16, 2024
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
