Breaking the cycle of neglect and panic – Euractiv

The current global public health emergency of international concern (PHEIC) for porcine parvovirus is another reminder that ignoring a public health emergency in one part of the world can have consequences for everyone, write Dr Hans-Hennie P. Kluge and Peter Piot.

Dr Hans Henri P. Kluge, Regional Director of the WHO Regional Office for Europe, and Peter Piot, Professor of Global Health at the London School of Hygiene and Tropical Medicine and Special Advisor to Ursula von der Leyen, President for European and Global Health Security

It’s also a reminder of how quickly collective amnesia can set in when it comes to learning the painful lessons of the past, such as smallpox, HIV/AIDS, Ebola and the COVID-19 pandemic.

African poxvirus has been present in multiple regions of Africa for at least four decades, spreading from animals to humans, but has long been ignored by the global health community. Like many infectious diseases, if it is not controlled, new modes of transmission and new offshoots or strains will emerge.

Since mpox was previously only found in Africa, the rest of the world chose to ignore it.

That changed two years ago, when Europe became the initial epicenter of the world’s second MPOX outbreak, triggering the first WHO emergency declaration for MPOX that lasted about a year. Early cases were imported through travel to Africa, and the outbreak primarily affected men who have sex with men.

Clade II is labeled “relatively mild,” although many infected people suffer from painful lesions and other complications that often last weeks or months before subsiding. A few people with major immunocompromises have lost their lives.

Europe’s response was rapid in 2022. Strong surveillance, contact tracing, active engagement by health authorities with high-risk groups, and improvements in the smallpox vaccine made the outbreak much easier to control.

The long tail effect of European MPox

Yet Europe’s fight against poxviruses remains an unfinished success story. Countries have exhausted their energy and resolve before transmission in our communities was eliminated. Every month, we still see around 100 new type II cases in the European region. What epidemiologists call the “long tail” of the 2022 poxvirus outbreak has gone on for too long.

This year, the re-emergence of ASFV clade I, coupled with the emergence of the rapidly spreading subclade Ib, prompted the Africa CDC to declare a public health emergency on the continent for the first time, and shortly thereafter the World Health Organization declared ASFV a Public Health Emergency of International Concern for the second time.

Since the beginning of the year, more than 500 suspected mpox virus type Ib deaths have been reported in East and Central Africa, the vast majority of which occurred in the Democratic Republic of the Congo (DRC).

Despite the complexity, one thing is clear: mpox is not the new COVID, nor is it the new HIV/AIDS. Its emergence and spread will not cause the same scale of destruction as the epidemic.

The good news in all of this is that we know what to do.

Three key approaches

In the coming weeks and months, protecting Europe and the rest of the world from MPox will require three main approaches.

First, strengthen surveillance for poxvirus types 1 and 2 by enhancing testing and reporting mechanisms so that cases can be rapidly detected, isolated, and treated.

This means raising awareness among clinicians, strengthening laboratory diagnostic capacity, and sharing data on suspected cases in a timely and transparent manner.

Furthermore, there is close coordination between policymakers, health service providers and community organizations serving at-risk populations, which in many European countries now include diaspora communities with links to affected countries in Africa.

Second, make sustained and strategic vaccine investments in Africa and Europe.

Currently, global MPOx vaccine production is severely limited, with demand far outstripping supply.

During the COVID-19 pandemic, we have seen the dangers of vaccine nationalism, where rich countries have secured vaccines at the expense of poorer ones. We can avoid this mistake if Europe commits to equitable distribution of vaccines around the world.

The European Commission, through the Health Emergency Response and Preparedness Agency (HERA), has donated around 200,000 doses of the Bayer Nord vaccine to the Democratic Republic of the Congo through the Africa CDC, demonstrating a path of international solidarity, and several other countries have now joined in the donation.

This gets to the third pillar of our response: real equity in access to vital interventions.

Although Europe has strong resources to defend against poxviruses, we need to do better. It makes no sense that poxviruses would continue to circulate among populations in Europe that often face discrimination, especially given how poxviruses can mutate—as has been the case in Africa.

Yet Europe’s efforts will be meaningless if the virus continues to rage elsewhere. Nowhere is a coordinated global response more needed than in Africa, a region that has long been hardest hit by the pandemic but has received little attention and resources.

European leaders can play a key role here, not only by ensuring vaccine equity but also by mustering collective political will by investing in health infrastructure and supporting local efforts to strengthen disease surveillance and response capacities.

Finally, we need to remember what we don’t need.

Travel restrictions or bans are counterproductive. They will not prevent travel, but they will reduce the likelihood of travel-associated cases seeking medical care.

We do not need discrimination – especially in a healthcare setting – to prevent people from seeking the care they need. Trust is essential to MPOX across our entire healthcare system.

Now is the time for Europe to build trust in the region and beyond, to respond to pox at home and abroad. Now is the time for Europe to act decisively and compassionately. And, more fundamentally, now is the time to break the cycle of neglect and panic that has dominated the response to pox and other epidemics for too long.