Monkeypox should serve as a global health wake-up call about when we act and why

Monkey pox in Mbaiki

Central African Republic 2018 © Mack Alix Mushitsi/MSF

By Jason Nickerson, humanitarian representative to Canada, and Carol Devine, humanitarian affairs adviser on climate, environment, and health, at Doctors Without Borders/Médecins Sans Frontières (MSF). An earlier version of this opinion column ran in The Globe and Mail.

On May 7, a case of monkeypox was reported in Britain. A little more than three months later, nearly 40,000 cases have been confirmed globally. Of course, the rapid, as-yet-unexplained international spread of the disease raises concerns, but we should understand that this situation differs from COVID-19 in important ways. Perhaps the most crucial one is that monkeypox is not a new disease. It had just received little attention outside the endemic countries of West and Central Africa until recently, when wealthy nations were affected.

Our organization has responded to previous monkeypox outbreaks, such as in the Central African Republic in 2018. And while we can’t offer clear answers to the many questions surrounding this current outbreak, this much is clear to us: The risk of new viruses causing infectious disease outbreaks is high, while patterns of existing infectious diseases are changing—and we’re woefully underprepared.

In particular, global and local changes to the Earth’s climate and environment are driving new opportunities for virus sharing between animal species. A recent modelling paper estimates that in the next 50 years, there will be at least 15,000 cross-species transmission events of at least one novel virus as a result of changing climates. Some of these will spill over and infect humans.

Already, our teams have seen climate-driven changes in disease patterns of vector-borne diseases such as malaria, a parasitic disease that already kills more than half a million people each year, most of them children. Typically, these diseases follow seasonal patterns, with peaks and valleys in cases. But in Niger, where MSF has worked since 2012, we’ve seen significant spikes in cases that are higher than annual averages, and in other climate-sensitive places where we work we worry that we’ll see increasing numbers of patients with mosquito-borne diseases such as malaria and dengue, as warmer temperatures and changing seasonal rains create breeding grounds for mosquitoes. We worry, too, about zoonotic diseases like Lassa fever, a viral hemorrhagic disease endemic to North and West Africa, though cases are increasingly being seen in new areas. And these are just the diseases that we already know about.

However, many of these existing infectious diseases with significant public-health burdens have long attracted little to no investment in new diagnostic testing, vaccines, and treatments. Diseases such as monkeypox, Ebola virus, Marburg virus, and Lassa fever, which have been identified as having pandemic potential, have for years posed a public-health threat to millions of people, mostly living in low-income countries, but almost all innovation for vaccines and treatments for these diseases comes only when rich countries perceive a threat, and pharmaceutical companies see a profitable market. By and large, it has fallen to governments such as Canada’s to invest significant amounts of public funds in developing them; this approach, however, rarely gets things to the finish line.

The Canadian-developed Ebola vaccine is a prime example. Developed at the National Microbiology Laboratory, the absence of an effective government strategy to take it from lab to patient and a lack of commercial interest led to it sitting on a shelf for years; it only got dusted off and launched once the major humanitarian crisis of West Africa’s 2013 outbreak attracted international attention as a biosecurity issue. The same lab has developed promising candidates for Marburg virus and Lassa fever, yet a lack of support has meant that they have not yet been delivered. Existing market-based approaches to develop such potentially valuable public-health tools are clearly not working, leaving not-for-profit drug and vaccine development organizations to pick up some of the slack by developing drugs and vaccines that have been neglected by the pharmaceutical industry.

The situation for monkeypox is slightly different. Its similarities to smallpox mean that vaccines and therapeutics exist, though once again there is inequity in access as most doses have been allocated to the stockpiles of rich countries, rather than the public-health needs of places where the virus is endemic.

If the world wants to get serious about getting ahead of future pandemic threats, it will require serious investment in the research and development of diagnostic tests, vaccines, and therapeutics for public-health threats wherever they exist, rather than waiting until they imperil wealthy countries or create lucrative markets. The COVID-19 pandemic has shown us that today’s local risk can quickly become the global health risk of tomorrow, and the only way forward is to put lives over profit.