Public Health Ontario (PHO) said there were 367 confirmed cases of monkeypox in the province on Thursday, up from 326 on Monday.
Moves by rich countries to buy large quantities of monkeypox vaccine, while declining to share doses with Africa, could leave millions unprotected against a more dangerous version of the disease and risk the continued spread of the virus to humans, public health officials warn.
Critics fear a repeat of the catastrophic inequality problems seen during the coronavirus pandemic.
“The mistakes we saw during the COVID-19 pandemic are already being repeated,” said Dr. Boghuma Kabisen Titanji, assistant professor of medicine at Emory University.
While rich countries have ordered millions of vaccines to stop monkeypox at their borders, none have announced plans to share doses with Africa, where a more lethal form of monkeypox is spreading than in the West.
So far, more than 21,000 cases of monkeypox have been reported in nearly 80 countries since May, with about 75 suspected deaths in Africa, mainly in Nigeria and Congo. On Friday, Brazil and Spain reported monkeypox-related deaths, the first to be reported outside Africa.
Public Health Ontario (PHO) said there were 367 confirmed cases of monkeypox in the province on Thursday, up from 326 on Monday.
Almost all affected people are men, with only two reported in female patients.
The report says 11 people have been hospitalized with the disease and two are in intensive care.
He says there are also 12 probable cases, 10 of which are men.
“African countries dealing with monkeypox outbreaks for decades have been relegated to a footnote in conversations about the global response,” Titanji said.
Scientists say that unlike campaigns to stop COVID-19, mass vaccination against monkeypox will not be necessary. They believe that the targeted use of available doses, along with other measures, could shut down the expanding epidemics recently designated by the World Health Organization (WHO) as a global emergency.
Although monkeypox is much more difficult to spread than COVID-19, experts warn that if the disease spreads to the general population, it is currently circulating almost exclusively among gay and bisexual men in Europe and North America , the need for vaccines could intensify, esp. if the virus takes root in new regions.
On Thursday, the Africa Centers for Disease Control and Prevention called for the continent to be prioritized for vaccines, saying it was once again being left behind.
“If we’re not safe, the rest of the world isn’t,” said Ahmed Ogwell, acting director of the Africa Centers for Disease Control and Prevention.
Although it has been endemic in parts of Africa for decades, monkeypox primarily jumps to people from infected wild animals and typically has not spread much beyond the continent.
Experts suspect that outbreaks of monkeypox in North America and Europe may have originated in Africa long before the disease began to spread sexually in two radishes in Spain and Belgium. Currently, more than 70% of the world’s cases of monkeypox are in Europe, and 98% of cases are in men who have sex with men.
WHO is developing a vaccine-sharing mechanism for affected countries, but has released few details about how it might work. The United Nations health agency has made no guarantees about the priority of poor countries in Africa, saying only that vaccines would be dispensed based on epidemiological need.
Some experts fear the mechanism could duplicate the problems seen with COVAX, which was created by the WHO and its partners in 2020 to try to ensure poorer countries receive COVID-19 vaccinations. COVAX failed repeated goals to share vaccines with poorer nations and sometimes relied on donations.
“It won’t be enough to ask countries to share,” said Sharmila Shetty, vaccines adviser for Doctors Without Borders. “The longer monkeypox circulates, the more likely it is to enter new animal reservoirs or spread to the general human population,” he said. “If that happens, vaccine needs could change substantially.”
At the moment, there is only one producer of the most advanced monkeypox vaccine: the Danish company Bavarian Nordic. Its production capacity this year is about 30 million doses, with about 16 million vaccines now available.
In May, Bavarian Nordic asked the U.S. to release more than 215,000 doses it was due to receive, “to help with international requests the company was receiving,” and the U.S. complied, according to Health Department spokesman Bill Hall and Health Human Services. The US will still receive the doses, but at a later date.
The company declined to specify which countries it was targeting the doses to.
Hall said the United States has made no other pledges to share vaccines. The United States has ordered by far the most doses, with 13 million set aside, although only about 1.4 million have been delivered.
Some African officials said it would be wise to stockpile some doses on the continent, especially given the difficulty Western countries have had in stopping monkeypox.
“I really didn’t think this would spread very far because monkeypox doesn’t spread like COVID,” said Salim Abdool Karim, an infectious disease epidemiologist at the University of KwaZulu-Natal in South Africa. “Africa should purchase some vaccines in case we need them, but we should prioritize diagnosis and surveillance to know who to target,” he said. “Normally, you can get ahead of a disease like monkey pox, but I’m concerned (the number of new cases) hasn’t started to come down yet.”
Dr. Ingrid Katz, a global health expert at Harvard University, said monkeypox outbreaks were “potentially manageable” if limited vaccines were properly distributed. She believed that it was still possible to prevent monkeypox from becoming a pandemic, but that “we must be thoughtful in our prevention strategies and quick in our response.”
In Spain, which has the largest smallpox outbreak in Europe, the demand for vaccines far exceeds the supply.
“There is a real gap between the number of vaccines we currently have available and the people who could benefit from them,” said Pep Coll, medical director of a health center in Barcelona that was dispensing vaccines this week.
Daniel Rofin, 41, was more than happy to receive a dose recently. He said he decided to get vaccinated for the same reasons he was vaccinated against COVID-19.
“I feel reassured that it’s a way to stop the spread,” he said. “We (gay men) are a group at risk.”