The World Health Organization (WHO) logo is seen near its headquarters in Geneva in February, 2023.Denis Balibouse/Reuters
The Globe’s health columnist André Picard answered reader questions about the fast-surging mpox outbreak in Africa. Last week, the World Health Organization declared it a global public-health emergency, with the virus increasingly jeopardizing the lives of children and posing a threat of spreading to other regions of the world. Mpox, previously known as monkeypox, causes lesions and flu-like symptoms, and is usually mild. But the new variant is triggering more severe illness, and the fatality rate this year has increased to between 3 and 4 per cent.
Readers asked about Canada’s mpox vaccine supply, how the public-health emergency affects travel plans and whether mpox is shaping up to be a new pandemic. Here are some highlights from the Aug. 21 Q+A.
The impact of the global public-health emergency declaration
Why was mpox declared a public health emergency?
André Picard: Mpox has been declared a public health emergency of international concern because of a large outbreak centred in the Democratic Republic of Congo that has spread to 13 countries in Africa. To date there has been only one case of clade 1 mpox (a new, seemingly more infectious strain) outside of Africa. Simultaneously, there is an ongoing outbreak of clade 2 mpox that is spreading principally among men who have sex with men, including in Canada. This is not a novel virus like COVID-19 was. It has been around a long time. We have vaccines and we have treatments. Currently, most people in Canada should not be worried but public health should be vigilant.
How is this mpox variant different from previous ones?
Picard: The new mpox variant (clade 1b) is different from the other circulating strain (clade 2) in a couple of important ways: It seems to spread more readily, through casual contact rather than skin-to-skin contact (whether it’s airborne is still a topic of fierce debate); it also seems to cause more severe symptoms and be more deadly. There are virtually no deaths from clade 2, the one largely spreading among men who have sex with men. The large outbreak in the Democratic Republic of Congo has a death rate of 3-5 per cent. However, this could be misleading because many mild cases go undetected and unreported.
How worried should we be? Can I assure my daughter that her university years won’t be as disrupted by mpox as her high school years were by COVID-19?
Picard: Young people suffered terribly from the disruptions and social isolation caused by COVID. But the situation with mpox is very different than with COVID-19. We don’t know how easily the new strain of mpox (clade 1b) can spread but, so far, the case numbers have not exploded the way they did in the early days of COVID. Your daughter should enjoy her university studies and not be unduly worried.
Is the WHO dealing with this public health emergency any different than it did for COVID-19 four years ago?
Picard: WHO seems to have learned lessons from COVID-19. When that novel virus emerged, WHO dithered and waited before declaring a PHEIC (public health emergency of international concern.) This time around, with the new strain of mpox, it acted early and cautiously. Of course, some will say it overreacted, as we have not seen any spread of the new mpox clade outside of Africa to date.
Doses of Bavarian Nordic's Imvanex vaccine, used to protect against mpox virus, are pictured at the Edison municipal vaccination centre in Paris, France July 27, 2022.Pool/Reuters
Canada’s mpox vaccine supply
If Canada has vaccines for mpox, why are we not sending them over to countries who need it?
Picard: Canada does have a stockpile of mpox vaccine, but currently has no plans to share. It’s not entirely clear why, other than to have vaccines available in case mpox does spread to Canada. Sadly, Canada has a reputation as a vaccine hoarder. During COVID, we had millions of excess doses that we didn’t share with countries in need. The Globe’s Africa correspondent, Geoffrey York, had an excellent article on this topic.
How mpox is affecting travellers
We are travelling to Kenya in September for a safari. Should we look into getting the mpox vaccine?
Picard: The WHO says travellers to affected countries should “consider” mpox vaccination, especially if they are in higher-risk categories. The epicentre of the outbreak is in the Democratic Republic of Congo, but it has spread to 13 countries in Africa including Kenya. High-risk groups include men who have sex with men and sex workers.
I’m heading to east Africa in October. Are these vaccines in Canada being made readily available to travellers, given the health emergency declaration?
Picard: The Public Health Agency of Canada says travellers should “consult a health care provider or visit a travel health clinic preferably at least 6 weeks before you travel.” There are currently no travel restrictions or mandatory vaccine requirements to travel to any country in Africa. There are vaccines available but, remember, travel vaccines are generally not publicly covered. Imvamune, the vaccine, is about $100 a dose, and you need two shots six weeks apart.
It should be noted, however, that mpox vaccine is available, at no cost, for high-risk individuals, such as men who have sex with men and sex workers. However, due to surging demand, it is hard to get an appointment in the City of Toronto. In other cities, like Montreal, the shot is being offered at mobile clinics in and near the Gay Village.
Mpox and other viruses
Is there any cross-immunity between mpox and other pox viruses (like chickenpox or smallpox)?
Picard: Yes, there is cross-immunity with smallpox. If you had a smallpox vaccine (which means you have a vaccination scar on your upper arm), you should be protected from mpox. However, Canada stopped routine smallpox vaccination in 1972, so that only applies to us old-timers. There is no cross-immunity with chickenpox, which is actually a herpes virus.
Does the resurgence of mpox have to do with the distance in time since the population was immunized against smallpox?
Picard: No. Smallpox was one of the most devastating diseases known to humanity and caused millions of deaths before it was eradicated in 1980. (Eradication was possible because there is no animal host.) Mpox is a virus that has been around for decades. It is spread largely by contact with rodents. (Mpox used to be called monkeypox, but that was misleading because it wasn’t spread by monkeys.)
The current resurgence has two fundamental causes: Clade 2 is spreading because there is more unprotected sex among men who have sex with men (which is why there is an explosion of syphilis cases too), and clade 1 is spreading because the virus has mutated and has become more virulent. We also can’t ignore the fact that infectious diseases always surge in conditions of war, poverty, poor housing, malnutrition, etc. The Democratic Republic of Congo, the epicentre of the outbreak, has all these and more.
