BY DEFNE DENİZ AYDİN

As monkeypox is spreading throughout the world, people are having déjà-vu not only of COVID-19 but also of the HIV-AIDS epidemic.

The COVID-19 pandemic has scarred the world deeply. A total of 595 millions of cases and 6.45 millions of deceased still continue to haunt us. The outbreak of the monkeypox virus and the decision of the W.H.O. (World Health Organization) Director-General declaring it a PHEIC (public health emergency of international concern) is sadly a familiar scenario. 

Are we ready to go through with yet another pandemic? Should we restock masks? Do we have to excessively wash the packaging of products again? Will there be other quarantines? Should I download Zoom again?

These are all questions that average pandemic survivors have asked themselves.

Monkeypox is an old friend. First discovered in monkey colonies and named in 1958, the disease has been detected in humans since 1970. The first declared case of human monkeypox was in the Democratic Republic of Congo. Since 1970, human cases of monkeypox have been reported in 11 African countries. The first case reported outside of Africa was in the United States of America in 2003. 

Since 2017, after a large outbreak in Nigeria, the virus has been slowly spreading to the world. Prior to that, the only cases outside of Africa were brought to countries from travelers or animal imports as rodents and other non-human primates are potential monkeypox reservoirs. In May 2022, monkeypox caught the attention of the world and the number of cases has been rising ever since. The C.D.C. (US Centers for Disease Control and Prevention) published a map to keep track of the number of cases and deaths reported. The number of infected people is over 41300, cases have been detected across more than 90 countries, and there are 12 deaths.

Scientists have yet to identify the genetic properties of monkeypox in order to state with certainty the modes of transmission of the virus. New studies show that the primary medium of transmission is close physical contact with an infected person (or animal). A study conducted in Spain showed that cultures from lesions contained much more viruses than cultures from throat swabs. This would mean that contact is a much more effective way of transmission. This doesn’t rule out the possibility of transmission by respiratory droplets, contact with infected material (like bedding) or bodily fluids. While we are certain that close contact is a form of transmission, research has yet to prove that monkeypox could be a sexually transmitted disease.

Monkeypox is a viral zoonosis that belongs to the Poxviridae family as well as the variola virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms but monkeypox is clinically less severe and has a lower death rate (ranging from 0 to 10%). Some common symptoms include fever, chills, headaches, exhaustion along with rashes that may be painful or itchy. 

Even though monkeypox research does not have that much funding, we are in a better position than we were when the first wave of COVID-19 hit us. 

It is no coincidence that we were able to develop the COVID-19 vaccines in such a short time. First of all, the RNA sequences of the virus were shared around the world as soon as the first case was reported. In addition, scientists were already researching the coronavirus family, so we were able to use this research for the development of new vaccines. In a limited time, faced with the global emergency, thanks to scientific collaborations, financial support and the acceleration of vaccine approval procedures by public authorities, biochemists and bioengineers have been able to develop several vaccines leveraging new technologies. 

A year and a half later, we are faced with a similar situation. The question is, will we be able to contain and eradicate the virus?

First of all, smallpox and monkeypox are genetically similar. This means that treatment used for smallpox is also to some extent effective for monkeypox. However, no treatment has been developed yet specifically for monkeypox. Even so, monkeypox symptoms tend to be mild and treatment is usually not necessary. Some symptom relievers can be enough of a treatment. Antiviral drugs developed for smallpox can be used to treat severe cases (patients with immune diseases or with simply weak immune systems). 

As for vaccination, an attenuated version of a vaccine used during the smallpox eradication program in the 1980s, the JYNNEOS, the Modified Vaccinia Ankara (MVA) vaccine was approved in 2019 by the FDA (US Food and Drug Administration) for prevention of monkeypox and smallpox. According to the W.H.O., vaccination can be effective both pre-exposure and post-exposure. Also, monkeypox is a DNA virus, unlike covid which is an RNA virus. RNA viruses are less stable than DNA viruses so it should be easier to develop a vaccine for monkeypox compared to the case of covid. 

Thirdly, the W.H.O. has announced the monkeypox outbreak a PHEIC. This is the W.H.O.’s highest alarm. Since 2005, it has been declared 7 times (including the 23 July 2022 announcement for monkeypox). Among the seven, three are ongoing : 2014 decision for polio, 2020 decision for Covid-19 and now the decision for monkeypox. 

At this moment, we are at a crossroads. 

In January 2020, the W.H.O. declared a PHEIC for Covid-19. In March 2020, it was announced a pandemic. This increased global awareness and mobilized governments to take necessary measures. 

We might be in the same cycle of events. We have the opportunity to learn from past mistakes and do our best to eradicate the virus. Thanks to our painful experience with Covid-19, globally we are well equipped to deal with another pandemic. One might argue that this is a kind of social capital that we have developed over the last two years that we can rely on in case of a new pandemic. On the other hand, one may also argue that people may have developed apathy or complacency towards living under strict measures to fight a pandemic. 

The international society should contain and eradicate the monkeypox disease regardless of the probability of it turning into a pandemic. 

Controversy followed the announcement of the alert. Even though this will push organizations and governments to establish prevention policies, some members of the W.H.O. International Health Regulations Emergency Committee advised against “sounding the alarm”. 

LGBTQ+ communities can relate to some of these concerns as the majority of cases are seen in men who have sex with men. This may be because of positive health seeking behavior in this population group. Most cases are reported to sexual health clinics rather than somewhere else because monkeypox rashes can resemble some sexually transmitted diseases, including herpes and syphilis, according to the W.H.O. Monkeypox is no more a “gay disease” than it is an “African disease.” It can affect anyone.

The unsupported claim that this is a “gay disease” may evoke some flashbacks for members of the LGBTQ+ communities who advocated against stigma surrounding HIV-AIDS. Unfortunately, since then, not much has changed. People who want to discriminate or marginalize people for their sexual orientation can make up reasons to do so easily. The monkeypox virus is one of them, not unlike HIV-AIDS. We have to remember that the reason behind this is not just malice but also ignorance. Another example of such an ignorance is the killing of monkeys in Sao Paulo out of fear of monkeypox contagion on August 16th. 

Monkeypox may not be the new COVID-19 or the new HIV-AIDS. But we have to make sure that it won’t be the recurrence of past mistakes. It is up to us all to distinguish evidence-based information from malicious and ignorant claims so that our fight with monkeypox scores better than what we did with COVID-19 and HIV-AIDS.