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We have a small window to contain monkeypox: WHO

There is a small window to contain the monkeypox outbreak before it becomes endemic in many countries, said Dr Soumya Swaminathan, chief scientist at the World Health Organization (WHO). Depending on how it evolves, vaccines may be needed in future to control monkeypox, Swaminathan said in an email interview to Mint. The increasing likelihood of human-animal interactions will lead to more zoonotic infections, she added. Edited excerpts:

For two years, we have been living with Covid. Now, the WHO has declared monkeypox a global health emergency. Why are we seeing so many new disease outbreaks?
The world is more interconnected than ever. Monkeypox has been circulating in a number of African countries for decades and has been neglected in terms of research, attention and funding. This must change not just for monkeypox but for other neglected diseases in low- and-middle-income countries as the world is reminded yet again that health is an interconnected proposition.

What makes the current outbreak especially concerning is the rapid, continuing spread into new countries and regions through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations (IHR). Because of the increasing likelihood of human-animal interactions (loss of forests, trade and travel), we can expect more zoonotic infections to affect humans. Countries have also strengthened surveillance capacity and are able to detect and report these infections more efficiently now.

Do you think monkeypox is the next threat?
This is an outbreak that can be stopped if countries, communities and individuals inform themselves, take risks seriously, and take the steps needed to stop transmission and protect vulnerable groups. The outbreak can be stopped with the right strategies in the right groups. It’s therefore essential that all countries work closely with communities of men who have sex with men to design and deliver effective information and services and adopt measures that protect the health, human rights and dignity of affected communities. We urge countries to scale up response and to implement the recommendations included in the Public Health Emergency of International Concern (PHEIC) Declaration to bring the outbreak under control. While the current outbreak seems to be mostly spreading through sexual encounters and impacting MSM (men who have sex with men), monkeypox can spread by close skin-to-skin contact and through droplets; so anyone can get infected if exposed to an infectious individual.

In Africa, where the epidemiology of the disease is different and where children and young people are mostly affected, a different approach will be needed.

What kind of research is needed to understand the epidemiology of monkeypox?
The second meeting of the IHR Regulations (2005) Emergency Committee regarding the multi-country outbreak of monkeypox advised that all efforts should be made to use existing or new vaccines against monkeypox within a framework of collaborative clinical efficacy studies, using standardized design methods and data collection tools for clinical and outcome data, to rapidly increase evidence generation on efficacy and safety, collect data on the effectiveness of vaccines (e.g., such as comparison of one or two dose vaccine regimens), and conduct vaccine effectiveness studies.

Similarly, they urged that all efforts be made to use existing or new therapeutics and antiviral agents for the treatment of monkeypox cases within a framework of collaborative clinical efficacy studies, using standardized design methods and data collection tools for clinical and outcome data, to rapidly increase evidence generation on efficacy and safety.

When the use of vaccines and antivirals for monkeypox in the context of a collaborative research framework is not possible, use under expanded access protocols can be considered, such as the Monitored Emergency Use of Unregistered and Investigational Interventions (MEURI), under certain circumstances, using harmonized data collection for clinical outcomes (such as the WHO Global Clinical Platform for Monkeypox).

The WHO R&D blueprint team conducted a global consultation on 2 August to develop research approaches and protocols for the testing of monkeypox vaccines.

India has isolated the first monkeypox virus strain. Will it help the world develop an effective monkeypox vaccine?
Yes, India is a very good example of successful vaccine and medical product development. Therefore, countries should invest in sustainable and secure domestic manufacturing capacity. There are many vaccine manufacturers in middle-income countries that have produced vaccines that have been prequalified by WHO, showing they can meet international standards for quality, safety and efficacy.

We encourage all WHO member states to support the draft resolution on strengthening the local production of medicines and other health technologies for regional and global health security. WHO is also calling on companies with successful products to share know-how, intellectual property and data with other qualified vaccine manufacturers, including those in low-and middle-income countries.

Do you think monkeypox vaccines are required, as some pharma companies have already started work on treatments?
It will take some time to fully assess what is available and how these vaccines can be used to the greatest effect. In the meantime, every effort must be made to control the human-to-human spread of monkeypox through early case-finding and diagnosis, isolation and contact tracing. Information is a powerful tool: those most at risk need to have information on know-how to protect themselves and others.

There is a vaccine for monkeypox recently approved by some countries for which supplies are limited. Some countries may hold smallpox vaccine products which could be considered for use according to national guidance. Vaccine products may be available in limited quantities through national authorities, depending on the country. There is a small window to contain this infection before it becomes endemic in many countries. Depending on how it evolves, vaccines may be needed in the future to control monkeypox, in addition to public health measures. LiveMint

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