LONDON (AP) — The World Health Organization’s Europe chief warned Friday that monkeypox cases in the region have tripled in the last two weeks and urged countries to do more to ensure the previously rare disease does not become entrenched on the continent.
And African health authorities said they are treating the expanding monkeypox outbreak as an emergency, calling on rich countries to share limited supplies of vaccines to avoid equity problems seen during the COVID-19 pandemic.
WHO Europe chief Dr. Hans Kluge said in a statement that increased efforts were needed despite the U.N. health agency’s decision last week that the escalating outbreak did not yet warrant being declared a global health emergency.
“Urgent and coordinated action is imperative if we are to turn a corner in the race to reverse the ongoing spread of this disease,” Kluge said.
To date, more than 5,000 monkeypox cases have been reported from 51 countries worldwide that don’t normally report the disease, according to the U.S. Centers for Disease Control and Prevention. Kluge said the number of infections in Europe represents about 90% of the global total, with 31 countries in the WHO’s European region having identified cases.
Kluge said data reported to the WHO show that 99% of cases have been in men — the majority in men that have sex with men. But he said there were now “small numbers” of cases among household contacts, including children. Most people reported symptoms including a rash, fever, fatigue, muscle pain, vomiting and chills.
Scientists warn anyone who is in close physical contact with someone who has monkeypox or their clothing or bedsheets is at risk of infection. Vulnerable populations like children and pregnant women are thought more likely to suffer severe disease.
About 10% of patients were hospitalized for treatment or to be isolated, and one person was admitted to an intensive care unit. No deaths have been reported.
Kluge said the problem of stigmatization in some countries might make some people wary of seeking health care and said the WHO was working with partners including organizers of gay pride events.
In the U.K., which has the biggest monkeypox outbreak beyond Africa, officials have noted the disease is spreading in “defined sexual networks of gay, bisexual, or men who have sex with men.” British health authorities said there were no signs suggesting sustained transmission beyond those populations.
A leading WHO adviser said in May that the spike in cases in Europe was likely tied to sexual activity by men at two rave parties in Spain and Belgium.
Ahead of gay pride events in the U.K. this weekend, London’s top public health doctor asked people with symptoms of monkeypox, like swollen glands or blisters, to stay home.
Nevertheless in Africa the WHO says that according to detailed data from Ghana monkeypox cases were almost evenly split between men and women, and no spread has been detected among men who have sex with men.
WHO Europe director Kluge also said the procurement of vaccines “must apply the principles of equity.”
The main vaccine being used against monkeypox was originally developed for smallpox and the European Medicines Agency said this week it was beginning to evaluate whether it should be authorized for monkeypox. The WHO has said supplies of the vaccine, made by Bavarian Nordic, are extremely limited.
Countries including the U.K. and Germany have already begun vaccinating people at high risk of monkeypox; the U.K. recently widened its immunization program to mostly gay and bisexual men who have multiple sexual partners and are thought to be most vulnerable.
Until May, monkeypox had never been known to cause large outbreaks beyond parts of central and west Africa, where it’s been sickening people for decades, is endemic in several countries and mostly causes limited outbreaks when it jumps to people from infected wild animals.
To date, there have been about 1,800 suspected monkeypox cases in Africa, including more than 70 deaths, but only 109 have been lab-confirmed. The lack of laboratory diagnosis and weak surveillance means many cases are going undetected.
“This particular outbreak for us means an emergency,” said Ahmed Ogwell, the acting director of the Africa Centers for Disease Control.
The WHO says monkeypox has spread to African countries where it hasn’t previously been seen, including South Africa, Ghana and Morocco. But more than 90% of the continent’s infections are in Congo and Nigeria, according to WHO Africa director, Dr. Moeti Matshidiso.
Vaccines have never been used to stop monkeypox outbreaks in Africa; officials have relied mostly on contact tracing and isolation.
The WHO noted that similar to the scramble last year for COVID-19 vaccines, countries with supplies of vaccines for monkeypox are not yet sharing them with Africa.
“We do not have any donations that have been offered to (poorer) countries,” said Fiona Braka, who heads the WHO emergency response team in Africa. “We know that those countries that have some stocks, they are mainly reserving them for their own populations.”
Matshidiso said the WHO was in talks with manufacturers and countries with stockpiles to see if they might be shared.
“We would like to see the global spotlight on monkeypox act as a catalyst to beat this disease once and for all in Africa,” she said Thursday.
Clinics nationwide will begin offering vaccinations against monkeypox to anyone who may have been exposed to the virus, federal health officials announced on Tuesday.
Until now, immunizations were offered only to people with a known exposure.
States will receive doses of a safer and newer monkeypox vaccine called Jynneos from the federal stockpile, based on the number of cases and the proportion of the state’s population at risk for severe disease, the officials said at a news briefing.
State health authorities may also request supplies of an older vaccine developed for smallpox, which is believed to protect against monkeypox, as well.
The Department of Health and Human services will provide 56,000 doses of the Jynneos vaccine immediately and an additional 240,000 doses in the coming weeks. Another 750,000 doses are expected to become available over the summer, and a total of 1.6 million doses by the end of this year.
“This vaccine currently has some limitations on supply, and for this reason the administration’s current vaccine strategy prioritizes making it available to those who need it most urgently,” Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said.
The older smallpox vaccine, called ACAM2000, is associated with harsh side effects, including death, in people who are immunocompromised, pregnant women and older adults.
The new vaccination plan drew quick criticism from experts, who said the campaign was too small and slow to make an impact. The longer it takes to contain the monkeypox outbreak, the greater the chances that the virus will become entrenched in the United States, particularly among men who have sex with men, researchers warned.
“Many of us are concerned that the window is closing for us to be able to eliminate monkeypox,” said Dr. Celine Gounder, an infectious disease expert and editor at large for public health at Kaiser Health News.
“If we don’t start vaccinating more quickly and broadly, we’re going to have a very difficult time containing this,” she said. Ideally, tests and vaccines for monkeypox could have been offered at L.G.B.T.Q. Pride events across the country in order to reach men at high risk of contracting the virus, Dr. Gounder added.
Some experts said the plan was also unfair to men at risk who will not have access to the Jynneos vaccine, especially those who have H.I.V. and cannot safely take the older smallpox vaccine.
“There won’t be enough to meet the need,” said Elizabeth Finley, director of communications for the National Coalition of STD Directors. “Plus, without better testing capacity, a strategy based on contacts with a positive case falls flat.”
It’s also not clear what qualifies as a probable exposure, she added: “Do you need to know someone at the event tested positive, or do you just say, ‘Oh, I went to a rave and I want to be safe’?”
Many clinicians are worried about side effects and scarring from the older smallpox vaccine, as well as the misinformation and vaccine hesitancy they might fuel, Ms. Finley said. “We’ve had clinicians say that there’s no way in hell they would give somebody ACAM2000,” she said.
The Jynneos vaccine, on the other hand, has never been used on this scale, and federal health officials said they would watch for unexpected side effects.
The administration has so far provided more than 9,000 doses of Jynneos vaccine and 300 courses of antiviral treatments to 32 jurisdictions in the country, officials said on Tuesday.
The European Union is adopting a similar plan, sending 5,300 of its 100,000 Jynneos doses to Spain, which has the most cases, followed by Portugal, Germany and Belgium. Other member states will receive doses in July and August.
The number of monkeypox cases has risen sharply in many European countries and in the United States.
What to Know About the Monkeypox Virus
What is monkeypox? Monkeypox is a virus endemic in parts of Central and West Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.
As of June 28, there were 306 cases in 27 states and the District of Columbia, up from 156 cases a week earlier. The C.D.C. has activated its emergency operations center to better monitor and respond to the outbreak, Dr. Walensky said.
The reported numbers are likely to be underestimates, said Dr. Jay Varma, director of the Cornell Center for Pandemic Prevention and Response. “It’s pretty clear to me and I think many others that the epidemic is far larger in magnitude than what our official case counts suggest it is,” he said.
Given the rising numbers, the available doses are not likely to be enough to meet the demand. Washington’s health department offered 300 monkeypox vaccination appointments on Monday; the slots filled up in less than 15 minutes.
New York City, which had identified 55 cases of monkeypox as of Tuesday, had 1,000 doses of the Jynneos vaccine at hand. The city’s health department began administering the vaccines at a single clinic in Chelsea, where the clientele is largely affluent white men who have sex with men.
The city offered the first doses at noon on June 23. Less than two hours later, officials announced that the clinic could no longer accommodate walk-ins and had booked appointments through June 27. As of Tuesday, the city was still waiting for more vaccine doses to become available.
“It started and then it stopped, and it started without anyone being prepared, and I’m not sure when it’s coming back,” said Keletso Makofane, a social network epidemiologist at the FXB Center for Health and Human Rights at Harvard University.
“All of this uncertainty does not help us to cultivate the trust we need to have,” Dr. Makofane said.
Several experts also took issue with the location and said it would have been more equitable to offer the vaccines at clinics frequented by Black men with untreated H.I.V. and limited access to health care.