It must be said, it was not a unanimous decision within the WHO to eliminate the monkeypox virus to give that highest status, say professor of skin infections Henry de Vries and field epidemiologist Amrish Bardjoe. Ultimately, Director General Tedros Adhanom Ghebreyesus took the plunge last week.
‘Be quick’
Why? “The virus has already been found in more than seventy countries, the numbers continue to rise and people can become quite ill from it,” De Vries summarizes. “In addition, we now have the opportunity to bring the epidemic down with vaccination, quarantine and testing.”
Actually, the WHO is now saying: be quick, adds Baidjoe. “Then you can still vaccinate targeted groups in which you see it a lot, in order to limit the spread. If the virus circulates, you are further away from home than if you pull out all the stops now.”
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The virus is well known in Africa. “It has been around in Central and West Africa for decades. People do not get it through sexual contact,” says Henry de Vries, dermatologist at Amsterdam UMC and also involved in the vaccination campaign against the virus that started today.
818 cases in the Netherlands
“In Africa it is mainly about children and people in poor health. Anyone can get it. It is a painful infection for some. People have also died from it.” In the Netherlands (with now 818 confirmed cases) no one has been hospitalized with the virus so far. Across Europe, there are 200 hospital admissions and one patient ended up in intensive care.
The virus may be an old acquaintance, we also know a lot about it not about. De Vries: “We thought it manifested itself with blisters on the skin, but it could also be a skin rash. And what is alarming: more than half of the cases we test turn out to have it. That gives the feeling that we may be looking at the tip of the iceberg.” The dermatologist also knows that his Belgian colleagues have found that people without symptoms can also carry the virus.
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Epidemiologist Baidjoe sees raising the alert level primarily as a call to countries to do more to get the virus under control and to share new data about its spread. “The WHO insists that it seems that countries are not doing enough to get a grip on the virus, especially the Northern European countries. There the cases are rising and the vaccination campaigns are slowly getting started.”
Changing partners
In addition, the situation is difficult. It is difficult to talk without stigma about the group in which the virus spreads the most, (trans) men who have sex with men, especially those with changing partners.
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The virus spreads through contact, which does not necessarily have to be sexual contact. As the virus circulates more widely, we will see the virus more widely in society, Baidjoe predicts. There are also already a few cases among children, including one Dutch boy with an immune disorder.
‘Huge run on vaccines’
The monkeypox virus is currently being controlled with a vaccine against smallpox, Imvanex. The smallpox virus has long since disappeared, so there are few vaccines in stock worldwide. One manufacturer controls the production of the vaccine against monkeypox, says Henry de Vries. He already sees ‘vaccine nationalism’ emerging, as we saw with the corona vaccines. Rich countries that only think about themselves and buy in bulk.
“The manufacturer’s website states that an unnamed European country has purchased 1.5 million doses. Because of things like this, the WHO says: this is an outbreak that needs to be coordinated internationally. Because as long as there are countries where the vaccine is not available or much more limited, it will remain a threat to us as well.”
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70,000 vaccines in the Netherlands
The RIVM reports that in the Netherlands has 70,000 vaccines for preventive vaccination against monkey pox in the Netherlands. They were once ordered by the Ministry of Defense a few years ago. Anyone born after 1975 will need two shots. In addition, 10,000 vaccines go abroad, to places where few vaccines are in stock.
Today, the first to fall into a risk group received a vaccination. It concerns trans persons and men who have sex with men and use PReP (a preventive medicine against HIV) or are on the waiting list for this.
Trans people and men who have sex with men who have been tested for HIV and who have a high risk of contracting an STI, or who are known to the STI clinic because they have a high risk, will also receive an invitation. . In total, this concerns about 32,000 people. This means that almost all available vaccines have been covered.
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It is not yet clear what exactly the vaccine will do in the people who will be vaccinated. The smallpox vaccine helps against monkeypox, animal studies have shown. “But we don’t know how well it works,” says dermatologist De Vries.
“It won’t work 100 percent anyway, and it won’t work right away. But people will probably get sick less and the hope is that you will pass it on less easily.”
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