Although the World Health Organization (WHO) has declared monkeypox (MPOX) an international public health emergency, the number of cases continues to rise in Canada. The latest outbreak is a direct result of federal and provincial governments neglecting the threat posed by the smallpox virus, regardless of the virus clade.

Colorized transmission electron micrograph of MPOX particles (red) found in an infected cell (blue), cultured in the laboratory [AP Photo/NIAID]

As of mid-August, 164 cases had been recorded in the country this year, far surpassing the totals recorded by the Public Health Agency of Canada (PHAC) in 2023. The government was quick to note that the current spike is far below the numbers seen during the first wave of smallpox spreading globally in 2022, when more than a thousand people were infected in Canada before the outbreak was unceremoniously declared over.

Currently, the clade 1 strain of the mpox virus is ravaging parts of Central Africa, particularly the Democratic Republic of Congo (DRC), leading WHO to declare a second Public Health Emergency of International Concern (PHEIC) for the mpox virus in August. This declaration follows the emergence late last year of a new strain of smallpox, clade 1b, in South Kivu, one of the DRC’s 26 provinces in the east of the country.

The investigation reveals that the virus is now more easily transmitted from person to person, and there are concerns about the increase in the number of infections in the population and its potential spread both across the region and beyond the country’s borders. With a case fatality rate of 3.6%, this infection is far more deadly than infections with the clade 2b strain, which has spread to more than 100 countries worldwide.

The presence of the clade 1b strain in Sweden and Thailand could be the proverbial canary in the coal mine, signaling the all-too-real threat of rapid spread of this strain.

The complete abandonment of any semblance of response to the clade 2b outbreak in 2022 raises many concerns about how public health authorities will respond once the clade 1 strain takes hold.

The lack of a robust epidemiological response by Canadian health authorities to the current strain of the mpox virus is emblematic of the international anti-public health response. Time and again, public health statements and announcements downplay the dangers posed by the virus and attempt to provide false assurances that these pathogens do not pose a serious threat and that all the necessary tools are in place should they be needed. Statements such as that of Theresa Tam, Canada’s Chief Public Health Officer, who admitted that the absence of positive clade 1 samples in wastewater “could change,” should raise eyebrows.

The mpox virus is primarily affecting the province of Ontario, where 142 confirmed cases have been reported since the beginning of the year. So far, two cases have required hospitalization, but no one has died.

Few, if any, positive cases have been linked to international travel. After it emerged, the virus fueled a large outbreak driven entirely by local community transmission. Only 15 per cent of cases reported travelling outside the province in the 21 days before symptoms appeared, and the test positivity rate has been above 27.3 per cent since the end of June, according to the provincial health ministry.

This means that health authorities are pursuing a strategy of “living with the virus” – the same approach taken for the COVID-19 pandemic – rather than fighting to eradicate the disfiguring and potentially deadly mpox virus.

Officials are hoping that current treatments, primarily the antiviral Tecovirimat, combined with targeted vaccination of at-risk populations, can limit the spread of the disease. But people recommended to get vaccinated in Toronto are reporting significant delays in booking appointments. According to Toronto Public Health, post-exposure vaccines must be administered within two weeks of a first exposure. Such delays will be catastrophic in the event of a rapidly developing outbreak.

Furthermore, the use of Tecovirimat does not appear to reduce monkeypox lesions in children and adults in the DRC. What appears to make a difference in mortality is hospitalization and the provision of high-quality supportive care. But any widespread outbreak would very quickly overwhelm health facilities, which would then become vectors for the spread of the disease.

Health Canada maintains it has a “sufficient supply” of vaccines to slow the spread of the mpox virus, even as epidemiologists and other health professionals criticize the futility of this approach. One of them, quoted on the network CTV Newsnoted that “sooner or later, the fire will be there.”

CDC in Africa [signalent] that of the roughly 10 million vaccine doses needed to control the outbreak, only about 280,000 are available, less than three percent of the estimated need, even as rich countries hoard, stockpile, and refuse to share their vaccines. These same countries were hoarding COVID-19 vaccines, and actively blocked or delayed the patent exemption that could have allowed countries in the Global South to manufacture COVID-19 vaccines during the pandemic and eroded the equity clauses in the draft pandemic agreement following pressure from Big Pharma.

The Canadian government says it has no plans to draw on its vaccine stockpile, which includes millions of doses of smallpox vaccines that are considered effective against monkeypox. With the eradication of smallpox in the early 1980s, cohorts of young people never received a single smallpox vaccine in their lifetime.

Experts note that the characteristics of the monkeypox virus should make efforts to stop its spread much more manageable than those against COVID, even in the crowded conditions of camps for internally displaced people in war-torn DRC. The main obstacle to this goal remains, as with the COVID-19 pandemic, the relegation of public health to the profit interests of the capitalist ruling elite and the division of the world into competing nation-states.

(Article published in English on September 10, 2024)