Freddie Sayers discusses the latest outbreak with the senior WHO epidemiologist
There are now 90 cases of monkeypox confirmed in the UK, with numbers rapidly increasing across the rest of the world. The institutions and individuals involved in tackling the COVID pandemic have turned their attention to tracking new cases and stockpiling vaccines. A 21 day isolation period has been enforced for high risk contacts of cases in England.
Freddie Sayers spoke to Professor David Heymann of the London School of Hygiene and Tropical Medicine, one of the world’s most senior infectious disease epidemiologists. For 22 years he worked at the World Health Organisation in Geneva, as chief of the AIDS research programme and Assistant Director for Health Security. Before that he was in Africa for 13 years investigating, among other diseases, the spread of monkeypox.
How is Monkeypox spread?
Transmission mainly occurs from a sore or a lesion on a person who’s infected to a person who’s not infected by physical contact with that lesion. So if, for example, someone not infected touches a monkeypox sore on a person who is infected, that can transmit to the person uninfected through a microscopic opening in the skin. So it’s physical contact that is the major way in which this infection is transferred from one person to another.
Is it a sexually transmitted disease?
A few years ago, in Nigeria, they did identify that there was a possibility that some of their transmission could have been by contact in the genital area. They actually identified some people who had genital lesions. Now this would not be a sexually-transmitted infection. This would just be transmission by close contact of that region from one person to another. But that’s only a hypothesis that occurred at that time; there was no proof.
Could the increased prevalence be connected to the lack of vaccination against Smallpox?
Yes, it’s a very important hypothesis, because in 1980, when smallpox was certified as eradicated, one of the major concerns was would monkeypox – and this is the Central African virus strain, which is much different than the West Africa strain – would that strain replace smallpox, because it causes a disease very similar in appearance to smallpox, it has a high mortality rate of 10% and infection is prevented by vaccination. So there was a great concern after eradication that this could possibly replace human smallpox as vaccination coverage decreased because vaccination was stopped in 1980.
Could the increased prevalence be connected to the Covid vaccines?
That’s highly unlikely. All vaccination programmes are continuing to go on and none of them have been associated with with human monkeypox. There’s no possibility that the vaccines in use could convert into a monkeypox strain. That’s just not a possibility.
Is Monkeypox exclusively found among gay and bisexual men?
Right now, it’s gay men who are being examined, and there’s increased surveillance looking for disease among them, and likely will be found. What’s not occurring, though, is a look in other populations that might be at risk also. So I think it’s very unfortunate that people would talk about one community as being at risk when we need to make sure that we’re examining all portions of population and understanding where the virus is actually transmitted at present. And as I said, this is an amplification of transmission due to behaviour where there’s close physical contact, and that physical contact in certain populations is in the genital area. Could be a sore on the thigh, it could be on the penis, it could be anywhere. And there may be a possibility that this virus also causes lesions that are on the mucus membranes. So we just don’t understand enough about it at present to really make any predictions or to really accuse any one population.
What cautionary steps, if any, should people take?
We can each prevent ourselves from getting infected if we do a risk assessment before we have close physical contact with another person who we feel might have been exposed to human monkeypox: am I planning to have close physical contact, or am I planning to take care of someone who has open skin lesions? That could be human monkeypox.
Are gay and bisexual men particularly susceptible in some way?
No, I think what’s happened is that the virus has entered a population, which because of behaviour is amplifying transmission, and when transmission is amplified, then it can continue to spread until people take the appropriate measures. It’s not a sexually transmitted infection. It’s an infection that’s transmitted by close physical contact. And in some instances, the lesions are in an area that is in the genital area where transmission occurs. But it also occurs in family clusters and it occurs wherever there’s contact with a lesion.
Is Monkeypox the next Covid?
The COVID pandemic has occurred because the virus has spread very easily from the nasal passages to other people. This is an entirely different virus. It’s transmitted by physical contact, and it would never have the same manifestations as does COVID-19. In fact, if you think back even the SARS outbreak in 2003, which many people remember, didn’t have the same transmissibility as the current coronavirus. So every virus is different. Every virus has its own way of transmitting, and the human monkeypox virus is not transmitted, at least in a major way, by the respiratory system… It will spread slower and hopefully it can be contained. There are, if necessary, just like for COVID-19, vaccines that could be used, but at present, their use would not be warranted on a large scale.
As a longstanding WHO official, what do you make of the Pandemic Treaty?
What we’ve seen in the COVID 19 pandemic is that countries want to do it on their own. There was very little global collaboration. Every country was trying different means of stopping infection and of preventing deaths. And gradually, they’ve all come around to the same strategy of vaccination. What’s important moving forward is that governments remember what happened at this pandemic, that they have in place surveillance systems, disease detection systems, to detect early and to respond early, and that includes all countries. So what’s going on right now is a recalibration in countries and a reexamination of global governance mechanisms. In fact, that’s going on this week at the World Health Assembly in Geneva, trying to better understand what the global community and what individual countries must do to better be prepared for the future.
That sounds concerning to people who are worried about undermining national sovereignty…
I think that countries would never give up their sovereignty in development of a treaty. But they would want it to provide an environment where they can have the necessary information and knowledge that they need, plus more equitable distribution of the requirements for pandemic preparedness and control.
Did the WHO perform well over the Covid pandemic?
I think the jury’s still out on how the World Health Organisation performed during this pandemic. What I can say though, is that the WHO has two arms, really. It has a political arm, which is what’s going on right now with the World Health Assembly, where ministers of health are together, deciding on priorities and discussing issues that are important politically. And then there’s a technical arm, which provides guidance to countries, and that technical arm has been functioning during the COVID pandemic, and providing evidence-based information. So, I think the jury’s still out on WHO, but until there’s something that could replace it, it’s a vital organisation for the world.