In a part of Nigeria that has dealt with monkeypox outbreaks for years, one doctor saw the photos circulating in Western media this week and chuckled.
“Those are the very severe cases,” said Oyewale Tomori, a virologist in the nation’s southwest. “Like, ‘Ahh! This is monkeypox!’”
The virus – discovered five decades ago in the Democratic Republic of Congo – causes mild illness in most people, along with blisters that usually clear up in weeks, he said. It’s much less transmissible than the coronavirus and much less deadly than Ebola. There’s already an effective vaccine.
What bothers infectious-disease experts across the continent is the double standard that has emerged since monkeypox grabbed the world’s attention: Few seemed to care, or even notice, until people in the West started getting sick.
In the past two weeks, cases of the animal-borne virus typically found in West and Central Africa have popped up in the United States, Canada, Australia, Israel and a growing number of European countries. There have been at least 92 confirmed infections and no deaths. Belgium has imposed a 21-day quarantine. President Biden assured Americans that the United States has enough vaccine stocks to address the threat.
Yet global alarm bells didn’t sound as several African nations battled outbreaks in recent months. The graphic images blazing across social media — some of the same ones used to illustrate monkeypox since the 1970s — rarely feature White patients.
“These cases are recorded in Europe,” Tomori said. “Why are you using a picture of an African? Those are your pox.”
The World Health Organization has not yet verified the origin of the outbreak, though one WHO adviser said the cases could be linked to raves in Spain and Belgium. Monkeypox usually spreads by close contact, including sexual activity.
Health officials suspect the virus has been travelling undetected in nonendemic nations for some time – potentially as far back as 2018. Early tests suggest cases stem from the West African strain, which the WHO said has a fatality rate of about one per cent.
Before monkeypox struck the West this year, the WHO said Nigeria, Cameroon and the Central African Republic all recorded small case numbers. But contact tracing is limited, said Yap Boum, a Cameroonian epidemiologist. Infections tend to arise in remote, forested areas, where people encounter wildlife that carry monkeypox, such as primates and rodents.
“Maybe now that it’s happening over there, the problem will get more attention,” Boum said, “and we will gain access to more vaccines, more treatments – all the things we did not have the money for.”
The Democratic Republic of Congo has been battling the world’s largest outbreak by far: at least 1,238 cases and 57 deaths since January. The strain found there is also much more deadly, with a fatality rate as high as 10 per cent. Many deaths are preventable, doctors said, but treatment can be hard to find in areas with underfunded hospitals.
“It can be devastating in the same way as covid-19,” said Health Minister Jean Jacques Mbungani. But the country’s monkeypox preparations lost steam during the pandemic. The nation needs more tests, more inoculations, more medical workers tracing cases and caring for the ill.
“The response is not effective,” Mbungani said, “and remains lethargic due to the scarcity of resources.”
The European Centre for Disease Control and Prevention said on Monday that the bulk of documented cases have been mild. Young children, pregnant women and people with weakened immune systems face a heightened risk.
One of Nigeria’s top genomic sequencing experts, Christian Happi, is inviting his counterparts to come study how his country has managed monkeypox.
“It’s not that scary here,” he said. “People are used to it. Come learn from our public health authorities. Come see how we contain it.”
The global enthusiasm to combat the virus should have arrived sooner, he said. Maybe it could have been eradicated by now.
“Paying attention to disease wherever it happens benefits everyone,” he said. “As the pandemic has shown us, we are all in this together.”
- The Washington Post report