Canada is in a time crunch to get monkeypox under control, before cases potentially spread further.
But health experts and advocates say a crucial opportunity could be squandered if governments don’t start taking the virus more seriously.
They are urging more action as three U.S. states declared monkeypox emergencies in recent days and the World Health Organization sounded the alarm over increasing cases.
“We’re at a crucial time period with the cases growing and spreading,” said Todd Coleman, an epidemiologist specializing in LGBTQ+ health, and an assistant professor at Wilfrid Laurier University.
Currently, monkeypox is primarily within communities of men who have sex with other men, but it’s “just a matter of time” before it spreads to more groups, he said.
Canada needs to mobilize public health services based on data, to focus on cutting chains of transmission, he said, through surveillance previously in place for COVID. Coleman wants to see more contact tracing.
“A mass vaccination availability based on exposure is really needed at this point,” he said. “It will still circulate if we don’t get every single chain blocked off.” He has seen “contradictory” and “inconsistent” information on who can get vaccinated.
The way monkeypox spreads means symptoms could take days or weeks to show up, and public health needs to target all chains of transmission by focusing vaccinations on those who may come into contact with monkeypox in the future, as opposed to only those in contact with positive cases, he said.
HIV/AIDS experts recently warned of the risks of treating monkeypox as if it will only affect one portion of society.
Dr. Theresa Tam, Canada’s chief public health officer, told a news conference last week that while the outbreak of the virus globally is a serious concern, there is “optimism that by focusing efforts in Canada and worldwide, we can seize this window of opportunity to contain the spread.”
There have been a few hundred cases across Canada, the majority in Toronto and Montreal, mainly affecting gay and bisexual men. But experts are watching closely, as the disease is quickly spreading across the U.S., with some cases in children.
To keep monkeypox from affecting more gay and bisexual men and spilling over to vulnerable populations including older people and children, federal and provincial governments need to take the virus much more seriously, health experts and advocates told the Star.
Contact tracing needs to be improved, financial help is needed for those isolating, vaccine needs to be available for high-risk groups, and public health messaging needs to be more clear about the risk and who is eligible for the vaccine, they said — or the virus could get much worse in Canada.
“We have to appreciate that we need to act quickly — viruses and emerging infectious diseases don’t wait for us to figure out what the playing field is before they make their next move,” said Jason Kindrachuk, an assistant professor in the department of medical microbiology and infectious diseases at the University of Manitoba.
“We’re always going to be somewhat behind the eight ball.”
While a specific tipping point where the outbreak would veer out of control is hard to predict, the more time a virus has to spread, bigger the risk it will find new groups of people, cause more severe cases or jump to new animal hosts, he said.
It’s not clear what will happen next: whether it will spill over to more vulnerable populations or stay relatively contained, with so much still to learn about the outbreak.
This is the first such outbreak that has gotten a real foothold outside of West and Central Africa, which has borne the brunt of this disease for decades; the first human case was identified in 1970 in what’s now the Democratic Republic of Congo. More severe outcomes have “tended to skew towards younger age groups,” said Kindrachuk, but there are still a lot of big questions about this “particular flavour of monkeypox.”
For example, historically, the disease has not been sexually transmitted, but it’s possible this could be a new form that is, he said, given that this outbreak has been confined almost entirely to gay, bisexual and other men who have sex with men.
The vaccine is in “short supply” but there’s “high demand,” Kindrachuk said, so it should be used “to make the biggest impact,” and right now that’s in communities of gay, bisexual and other men who have sex with men, even in places without known cases. To that end, the vaccine clinics set up so far have been meant for trans or cisgender people who identify as gay, bisexual or other men who have sex with men and who meet at least one other risk criteria.
On the issue of help for people with the virus, Tam said she has encouraged provinces and territories to implement supports but didn’t elaborate when asked by reporters.
Tam also said at the news conference that there is “limited supply” of the vaccine globally, but Canada has enough for now. She said 70,000 doses had been provided to provinces and territories and about 27,000 have been used, but she didn’t say how many doses each jurisdiction has received or how many Canada has stockpiled.
Over the weekend, Spain reported its second monkeypox death, according to The Associated Press. Local media also reported India’s first known death from the disease. These deaths should serve as a “wake-up call,” Kindrachuk added, “maybe in many people it is mild, but there is the potential for severe outcomes.”
Adding to the sense of urgency, several U.S. states declared emergencies in the last week.
On Monday, California Gov. Gavin Newsom declared a state of emergency, joining Illinois and New York in a move to streamline outbreak response and resources. The U.S. reported more than 5,800 confirmed cases of monkeypox as of Aug. 1. The Biden administration has faced criticism for a slow vaccine rollout, with long lineups indicating failures to meet demand, AP reported.
The World Health Organization declared monkeypox a public health emergency of international concern last month.
And at the International AIDS Conference 2022 conference in Montreal over the long weekend, a global gathering of leaders in the field, health experts discussed the monkeypox response and urged governments to quickly allocate more resources to contain the disease.
Many compared the monkeypox response to COVID and HIV and fear the same mistakes around lack of resources will be made. Treating monkeypox like it can only affect one portion of the population is a mistake similar to the response when HIV emerged, experts at the conference said.
There are also concerns about discrimination toward gay and bisexual men and stigma, which could deter some from getting help, also an issue with HIV/AIDS.
“There was a lot of HIV prevalence among gay men in the 1980s, but that does not mean it was a gay disease,” Praney Anand, executive director of the Alliance for South Asian AIDS Prevention, previously told the Star. “Similarly, we might be noticing some cases within pockets of communities that might be frequented by queer people, but that does not make it a gay pox.”
As of Aug. 1, Toronto Public Health and community partners had administered 14,289 doses of the monkeypox vaccine.
According to the most recent Public Health Ontario report as of August 2, there have been 423 confirmed cases in Ontario, including 329 in Toronto. Of the 423 cases, 421 are male, two female. No deaths have been reported, but two confirmed cases landed in the intensive care unit, and 11 were hospitalized.
Across Canada there are 890 confirmed cases as of July 29, including 373 in Quebec, 78 in B.C., 13 in Alberta, two in Saskatchewan and one in the Yukon along with Ontario’s cases.
Public health messaging on vaccine eligibility has also been disjointed , and the information should focus on vaccinations rather than on eliminating close contact, said Coleman.
Community groups are taking up a lot of the co-ordination around the vaccination campaign with a small budget, and public health should shoulder more of that, he said.
“People are still confused about who should and who shouldn’t get vaccinated for this. Having really clear and frank messaging from public health is key at this point, and we’re not quite seeing that still.”
GETTING THE SHOT
Who can get the monkeypox vaccine?
In Toronto and Ontario, the clinics are officially meant for high-risk individuals: trans or cisgender individuals who identify as gay, bisexual or other men who have sex with men and who meet at least one other risk criteria. For a detailed list, see Toronto Public Health’s website.
A spokesperson for Toronto Public Health did not respond to a question on if people would be turned away if they didn’t meet these criteria, which are hard to verify, but said in an email that “intermediate risk contacts may also be vaccinated, following an assessment of individual risks and benefits.”
Is there any kind of monkeypox vaccine receipt/record, like with COVID?
Toronto Public Health says individuals get a receipt after their vaccine. As well, information on each dose of vaccine is entered in the provincial immunization system, called Panorama.
What about my second dose, when can I get that?
There are two doses of the monkeypox vaccine (Imvamune). Ontario guidelines are currently only administering one dose of the vaccine, though Dr. Theresa Tam said last week that two doses could be possible depending on the severity of the spread and if wanning immunity becomes a concern.
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