The World Health Organization (WHO) has declared monkeypox a public health emergency of international concern. Probably up until about two months ago, many Canadians had not even heard of this disease.
Since May, monkeypox has been in the news everywhere, including Canada, where the number of infections reached 681 as of July 22. It began to spread from major cities like Toronto and Montreal to regional centers like Hamilton, where the first case was publicly reported on July 4.
The good news is this: monkeypox is still fairly isolated from the general population. There is still time to turn it back, and an effective vaccine is already available, although supplies are limited.
The bad news is that the window is short – a matter of weeks, not months – to vaccinate the most susceptible and to encourage and support self-isolation for those with symptoms. Monkeypox can then spread beyond our ability to control it with available vaccines.
Motivating individuals and governments to act may be challenging, however, given the degree of COVID-19 fatigue that has occurred and the erosion of trust in public health measures, including vaccines, due to misinformation.
Monkey pox
Monkeypox, a close relative of smallpox, first jumped humans in 1958. It became endemic to a group of countries in central and west Africa, but was of little interest elsewhere until it became a threat in North America and Europe.
A health worker prepares a monkeypox vaccine in Montreal, July 23, 2022. THE CANADIAN PRESS/Graham Hughes
What we’re seeing right now in Canada is that monkeypox is mostly affecting men who have sex with men. It’s not yet time to advise everyone to rush out and get a vaccine, but it’s certainly time to make sure those in the most affected communities understand the risk of infection, recognize the symptoms and take steps to protect themselves so are the others.
Although it has so far predominantly affected men in the 2SLGBTQ+ community, it is important to emphasize that monkeypox is not a “gay disease” at all. It is spread simply through close personal contact, which may or may not include sexual contact.
Read more: Monkey Pox FAQ: How is it transmitted? Where did you come from? What are the symptoms? Does the smallpox vaccine prevent it?
Given its current pattern of emergence in the 2SLGBTQ+ community, we must use the hard-earned lessons of the emergence of HIV/AIDS in the 1980s to avoid repeating the stigmatizing mistakes of that time, which were not only socially shameful, but also harmful for public health.
Lessons from HIV
In the 1980s and 1990s, many people were afraid to get tested because of the stigma associated with HIV, even within the health care system itself. Since then, the world has come a long way both in its treatment of 2SLGBTQ+ people and in its broader understanding of the infection.
However, many people did not want to know their HIV status back then because of the stigma. We can’t let that happen to monkeypox, as 2SLGBTQ+ advocates have noted.
Monkeypox is not as easily transmitted as COVID-19, but the fact is that we are all equally susceptible and we all need to be aware and prioritize measures that will quell this threat before it grows. The ongoing COVID-19 pandemic has demonstrated the value of vaccination and the need for infected people to self-isolate to prevent the spread, and we can apply these lessons to monkeypox outbreaks.
Symptoms of monkeypox are very rarely life-threatening and include high fever, chills, fatigue and muscle aches, followed by a characteristic rash. They usually take about 10 days to appear after exposure, but can happen anytime between five and 21 days. The infectivity usually takes two to three weeks to subside after that. Infectivity ends around the time the distinctive lesions of monkeypox finally clear up and disappear.
It is important that anyone who has had close contact with someone with monkeypox get vaccinated if symptoms have not developed and self-isolate if they do. (NIAID, cropped from original), CC BY
During the window between exposure and the onset of symptoms, there is a golden opportunity to prevent an individual disease and stop the spread of infection as a whole by vaccinating exposed people as quickly as possible. In this way, we can build a wall around the hearth.
Mobilization of resources
The HIV epidemic, while tragic, served to mobilize health resources for and from 2SLGBTQ+ communities, and today these existing networks are being activated to educate and support those most at risk during this phase of the monkeypox epidemic.
The Gay Men’s Sexual Health Alliance, for example, is proving to be a valuable hub for up-to-date and helpful information on monkeypox prevention, detection, and vaccination, including information about vaccine clinics.
It is vital that anyone who has had close contact with someone with monkeypox comes forward to be vaccinated if they have not developed symptoms and to isolate themselves if they do.
Self-isolation, as we’ve learned from COVID-19, is neither easy nor practical for many people. It is important that governments in Canada accelerate financial support that allows people with monkeypox to stay at home and limit the spread of the infection.
We’ve seen with both HIV and COVID-19 what happens when we don’t act in time. We know how to contain and end this epidemic, and we must act now.
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