Lessons from a Nigerian Virologist on Containing the Monkeypox Outbreak

Nigeria saw the outbreak of monkeypox in 2017, and the virus has remained endemic since. One of the leading Nigerian virologists, Dr. Oyewale Tomori, says that Western countries should focus on early detection and prevention of the disease, especially when there is insufficient data on vaccine efficacy.

Tomori, a professor of virology at Redeemer’s University and a member of the World Health Organization’s (WHO) Strategic Group of Experts on Immunization, says vaccines are only additional ammunition in fighting the monkeypox outbreak. As vaccines alone do not help most of the time, it is necessary to look at the mode of transmission.

“Take COVID-19, for example. People in Europe were vaccinated, but the disease spread. Because people were not taking precautions, the new variants emerged, nullifying the effect of the vaccines,” he said in the interview for Healthnews.

From September 2017 to the end of April 2022, a total of 558 suspected cases with 231 confirmed had been reported in Nigeria.

However, cases started increasing again this year when the outbreak spread to non-endemic countries, including the US. Nigeria's center for disease control said earlier in summer that at the current rate, the number of monkeypox infections in 2022 could be the highest in five years.

Tomori says awareness contributed to the rising numbers of confirmed cases. “With all the noise around monkeypox, more people have been tested when they had a rash.”

What could the US, with more than 14,000 confirmed cases of monkeypox, learn from Nigeria in containing the outbreak? Close and quick surveillance, Tomori says.

"Because the rash of monkeypox in early stages looks like the rash from other diseases. And if you do not know the source, what type of disease it is, it spreads in the community."

Tomori points out the lack of evidence on monkeypox vaccine efficacy. For example, JYNNEOS and ACAM2000 vaccines have never been tested in the real world against monkeypox.

"The disease will end if you isolate a patient early enough and help people protect themselves. So we need to focus on that aspect of disease transmission rather than vaccines. We do not have enough vaccines, but everybody can follow prevention methods."

Outbreaks are different

Tomori says the monkeypox outbreaks in parts of Africa differ from those in Europe and the US.

Firstly because there are two clades ⁠— or variants ⁠— circulating worldwide. Clade 1 was originally found in Central Africa, near the Congo Democratic Republic. It causes more severe infection resulting in more lesions and a mortality rate of about 10%.

Clade 2, which is now spreading in non-endemic countries, originated in West Africa. The infection causes smaller lesions, and a mortality rate is less than 1%.

Tomori says researchers are investigating why these clades differ in severity, but there is no clear answer yet. It could be due to the prevalence of HIV or an immunocompromised situation in Central Africa.

Another difference is the route of transmission. The first monkeypox case in Nigeria was detected in an 11 years old boy, and it is still unclear how he got infected. It is known that monkeypox spreads through direct contact with lesions but not necessarily through sexual contact. While in the West, men who have sex with men are primarily affected.

The WHO declared the monkeypox outbreak a public health emergency of international concern (PHEIC) in July 2022. However, Tomori says it should have been done earlier.

“The declaration was 50 years too late for Africa and two months too late for Europe. Because Europe started the rollout of vaccines even before PHEIC,” he said to Healthnews.

Tomori doesn’t think PHEIC will have a significant impact, either. “There are monkeypox or smallpox vaccines in the US and Europe, but there are no available vaccines in Nigeria. So what is the advantage of PHEIC for us? None,” he says.

Many of Tomori’s colleagues talked about double standards, as the WHO declared the monkeypox outbreak PHEIC only when the virus started spreading in the West. However, Tomori says he does not blame the WHO.

“We should have declared it a national emergency and not waited for the world to solve the problem for us.”

"Everyone should be worried"

Monkeypox is not the only virus that concerns Americans. The polio virus, which was officially declared eradicated in 2004, resurfaced in the US this year.

Tomori, who significantly contributed to Nigeria's efforts to eradicate polio, says everyone should be worried about it.

"Any disease anywhere that is neglected will spread anywhere. And that's the problem," he says.

"That's how we got COVID-19 from China to all the world. That's why now in Africa we get wild poliovirus in Malawi and Mozambique from Pakistan."

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