Scientists are concerned that the monkeypox outbreak could take the world, including SA, back to the days when HIV was taboo, warning that if nothing is done about the health response, those at high risk, mostly gay and bisexual men, could be shunned as they were in the early response to HIV.
SA public health researcher Keletso Makofane, a postdoctoral fellow at Harvard University, called the monkeypox global response “worse than the initial HIV response”. Not only has the response to monkeypox, which has affected more than 20,000 people in 78 countries, been slow, Makofane says the stigma perpetuated even by healthcare workers could make life more difficult for those affected.
Makofane, who has been involved in HIV research in SA for the past decade and is now researching the monkeypox virus among gay and bisexual men in New York City, said those affected are already feeling the stigma. He said more needs to be done to sensitise healthcare workers on this key population.
“We know that in HIV healthcare workers were not trained to serve gay and bisexual men. In treating monkeypox it’s unreasonable to think intervention will shift. You can’t expect now that there is monkeypox for these people to serve gay men. People go to healthcare workers and say, 'I think I have monkeypox', and healthcare workers say, 'I want nothing to do with this'.”
He said the outbreak happening right after Covid-19 led to general fatigue. Adding to that, richer nations such as the US had been holding on to millions of doses of a smallpox vaccine that had been approved to inoculate against monkeypox, while developing nations had limited or no vaccines.
Makofane said the stigma and slowness in responding to monkeypox was recently experienced by someone he knows — a US resident who visited Europe and came back with monkeypox symptoms. Despite explaining his travel history and symptoms that matched monkeypox, including “unbearable pain”, several doctors failed to test him for monkeypox.
It was only on the seventh day of showing symptoms and after going to four different healthcare providers that he tested for monkeypox.
“The doctors looked for everything he could possibly have, except for monkeypox. He only got helped after a fourth physician, who had a lot of influence, got involved and advocated for him to be swabbed. The clinician who tested him came dressed in a hazmat suit ... like he was afraid of his patient.
“Just imagine, if this is happening in a well-resourced nation such as the US ... how many other patients will probably be subjected to this behaviour as we get more cases across the world?”
Prof Glenda Gray, an HIV expert and the president of the SA Medical Research Council, also expressed worry about the stigma.
“You know, we are a country that likes to blame. So it does worry me that people and certain subgroups are going to be blamed ... that people are going to be stigmatised even by healthcare workers.
“Not only do we have to educate people who may be at risk but the very healthcare workers who look after them, as they also display a lot of stigmatising behaviour. We have to protect people who are susceptible and also make sure we don’t continue stigmatising people.”
Gray said research showed monkeypox is spread by intimate contact. SA has had three cases so far.
She said SA is now using the same surveillance tools used to trace Covid-19, including wastewater surveillance, to pick up any clusters or outbreaks.
“It’s important for us to see where we are going as a country, that we know the burden, that we know how to prevent it.”
Gray said SA was not looking at vaccinating against monkeypox yet. A vaccination programme would only target high-risk groups.
“We may have to do selected vaccination. We need to identify those who may be susceptible and then offer a vaccination when it is available and needed in our country.”
Dr Meg Doherty, director for the department of global HIV, hepatitis and STI programmes at the World Health Organisation (WHO), said of 35 countries that have asked for access to the vaccine, most were high-income ones such as Canada, the US and UK.
But she warned the world body is monitoring the procurement of vaccines closely to ensure equity and access for low-income countries while richer nations hoard the vaccines, as was the case during the Covid-19 pandemic.
“There is a risk that countries putting in for access are coming from high-income countries ... that’s quite a possible risk. We will have to watch out for this. As WHO we want equity. If WHO needs to be able to say that louder and stronger for those countries who are not getting access we will continue to do that. We can’t have monkeypox responses only responding to the UK, Canada and the US.
“We need a response that also addresses what’s happening in the DRC and Nigeria, where cases are going up. We are hearing cases around the world are going up. So that’s our mantra and that will be our goal,” she said.
Research shows people at risk of monkeypox are those living with HIV, mostly gay and bisexual men. On July 23, the WHO declared monkeypox a global health emergency, its highest-level warning.
Globally 22,485 cases have been confirmed.
“Our role as WHO is to ensure we work on a co-ordinated response for all the countermeasures and tools to address the outbreak, but also ensuring we don’t forget those countries that traditionally have monkeypox in west and central Africa. So our focus is very much an equitable response to ensure those tools and countermeasures are available,” Doherty said.
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