Again, the world is paying attention to another outbreak of infectious diseases. This time it’s the monkey’s smallpox, a rare disease that many people may never have heard of until recently. The name of a well-known primate: monkeys, due to the early origins of the disease. Its reappearance and spread to many countries around the world has caused world health leaders to go through a deep introspection while doing some analysis of the Johari window. In simple terms, the rapid spread of smallpox smallpox has led to the realization and in-depth analysis of the many known acquaintances, known unknowns and unknown unknowns about the disease.
It seems like a déjà vu, as Nigeria went through a similar scenario in 2017 when, unexpectedly, it recorded the sudden recurrence of cases of smallpox in many parts of the country, simultaneously a situation very similar to that we are witnessing worldwide. present. Back then, there were deep discussions about the same known unknowns, unknown unknowns, as we are having today and suffice it to say, it didn’t get much attention worldwide. Perhaps if the world had paid attention then, we would know more about this disease today.
As of June 2, 2022, cases of smallpox in monkeys continue to increase worldwide, with about 791 confirmed cases worldwide. In 2022, there were 21 confirmed cases of monkeypox in Nigeria on May 29, and one death.
The origins of monkeypox in Nigeria
The first cases of smallpox in Nigeria were reported in 1971 by a 4-year-old boy and a 24-year-old mother. The next known case was reported in 1978 and after that, everything seemed calm or at least no case was reported. The disease is thought to be zoonotic with occasional events of human transmission, but no host animal has ever been identified. Human defense against monkeypox can also be explained, to some extent, by the widespread use of the smallpox vaccine which offered cross-protection against monkeypox. Smallpox vaccination stopped worldwide in the early 1970s, following the eradication of the disease.
Cases of smallpox in monkeys seemed to disappear completely in Nigeria, but in 2017, after 39 years, the disease came back unexpectedly. Theories about why this happened included the possibility that poor surveillance systems meant that the virus could have circulated undetected and that improvements in surveillance, following the strengthening of the Nigerian Disease Control Center ( NCDC) meant that the virus was detected much more quickly. More cases were detected and at the end of 2017, of the 198 suspected cases, 88 were confirmed, which indicates a positive test rate of approximately 44%. At the start of the outbreak in 2017, the NCDC had limited testing capacity and the initial laboratory diagnosis was made at the Pasteur Institute in Dakar, Redeemers University and the Centers for Disease Control and Prevention. of the United States (CDC of the United States).
The reappearance of monkeypox
After the outbreak in 2017, Nigeria seemed to do everything according to the rule book. The country complied with the reporting requirements of the International Health Regulations (IHR) and notified the World Health Organization (WHO) of the outbreak. He shared data freely with all interested parties, through all possible means. From 2017 to date, more than 14 articles have been published in peer-reviewed journals related to all aspects of this new disease. Several gaps in the research were identified, and despite requests for support to do the research needed to cover the knowledge gaps in the published articles, there was little interest in the disease, as it appeared to affect only those living in the world. West and Central Africa. However, colleagues at the NCDC, the University of Niger Delta, Bayelsa State, Nigeria and its partners continued to publish their findings on the disease.
Then, cases began to be identified in travelers outside Nigeria. First of all, in the United Kingdom (UK), it is not surprising given the strong historical ties between the countries. But then in Singapore, Israel and the United States. Despite all these exported cases, the public health response followed a similar pattern of widespread media attention, deployment of enormous resources to manage cases in high-containment facilities, deployment of national capacities for the response of public health in all countries with cases with a history of travel. of Nigeria, and a return to the norm.
There seemed to be no interest in conducting further research to learn a little more about the origins of the virus, especially in regions where the virus was endemic. The only country that invested resources to work with the NCDC was the US through the US CDC. Along with the NCDC, there were elaborate studies, especially on the human animal interface to identify a host. One of the key unknowns about the virus is the knowledge about the natural reservoir of the virus, and as a result, any hope of understanding it later in the last five years has not been fully realized.
Lessons not learned
The COVID-19 pandemic exposed the profound challenges of getting governments to think beyond their national sovereignty and national interests to consider issues of equity and align themselves with global solidarity. Furthermore, there is a reality that given our understanding of infectious diseases, these ideas of national sovereignty on which we base our response instincts are irrelevant and cause more harm than good in the long run. The COVID-19 pandemic is likely to last much longer than necessary because the world has not worked together enough. But this will not be the first time this has happened, and the response to the appearance of smallpox has shown that we have not learned the lessons we need.
The global response to the monkeypox outbreak would definitely have been better if the world had come together in recent years to respond to this threat from “somewhere in Africa.” Perhaps if the countries with exported cases had also committed only a few resources to working with Nigeria to understand the origins and define a response, we would know a little more today.
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But there is also a lesson at the local level. It demonstrates the value of having a strong national public health agency and demonstrates why physicians, communities, and state governments need to come together and improve their capacity to respond to, and ensure that infectious disease outbreaks. there is sustained funding for epidemic preparedness and response. In addition, when suspicious cases arise, the NCDC has developed sequencing capability and increased experience in Abuja, so it is no longer necessary to seek external support for laboratory diagnosis.
In a recent media conference, Dr. Mike Ryan, Executive Director of the World Health Organization’s Health Emergencies Program, stated unequivocally, “I certainly haven’t felt this level of concern for the last five or 10 years” in response to questions about the spread of the virus. . disease in Europe. We need to operationalize “infectious diseases do not respect borders.” That’s not how things have ever worked, and the chronic lack of investment to do the necessary research has now cost us in terms of poor preparation. These are lessons that one would have thought we had already learned.