A day late and a dollar short on monkeypox

The people and politics driving global health.

Jun 16, 2022 View in browser   By Andrew Green, Carmen Paun and Daniel Payne THE BIG IDEA Though vaccines that likely work against monkeypox have been around for decades, few studies have been done on them for the virus in endemic regions. | James Gathany via the Centers for Disease Control and Prevention FACTORS THAT DRIVE MONKEYPOX OUTBREAK — Ahead of the global eruption of monkeypox cases, outbreaks of the disease were alreadyincreasing in West and Central Africa, where it has sporadically appeared for decades. For researchers in the region, it's a familiar cycle, like the West African Ebola outbreak that began in 2013, when attention and resources to an existing pathogen only increase after the disease threatens the global north. By the time countries to the north take notice , though, such diseases have cost lives and eroded development in the regions where the pathogen first emerged. At the same time, those regions are met with travel bans and stigma, instead of efforts to address the gaps in surveillance and equitable access to prevention and care that allowed the disease to emerge. "It shows the prevailing economic, sociopolitical system is not favorable toward equity" and needs a second look, John Amuasi, a Ghana-based expert on emerging infectious diseases, told Global Pulse. Richer nations often control the money to research and respond to emerging infectious diseases. That funding runs on a "boom-and-bust cycle depending on what funding agencies prioritize and what people think is relevant at the time," said Jonathan Epstein, vice president for science and outreach at the nonprofit EcoHealth Alliance. Amuasi said those boom cycles have offered opportunities to improve systems for detecting and responding to emerging infectious diseases in the global south, such as dramatically improving laboratory capacity amid the Ebola outbreak. But he and other experts said more work needs to be done. The priority should shift to preventing diseases from emerging at all, Epstein said. Many diseases crossover from animals. Stopping that spillover requires better understanding the risks — like deforestation or interactions, including wildlife trading or intensive livestock production — and trying to improve safety. It also requires boosting health care systems, even in remote locations, so cases are detected early. "It's a really big ask of everybody, including ministries of health," said Wesley Van Voorhis, an expert on emerging infectious diseases at the University of Washington in Seattle. And it can't ebb and flow with shifts in public attention because "if we don't have that, how are we going to pick stuff up?" And as health services improve, they need to be linked to the scaled-up laboratory and surveillance systems, Amuasi said. He also looks to the global south to access cutting-edge technology to develop tests, treatments and vaccines. While factors other than equity — including perceived national interests and potential profits from sales of limited treatments and vaccines — may be motivating behind how to apply resources to emerging infectious diseases, "we have to recognize these drivers for what they are and work them in the direction we want," Amuasi said. Andrew Green is a freelance writer in Berlin. WELCOME TO GLOBAL PULSE WELCOME BACK TO GLOBAL PULSE! There's a push to rename monkeypox. What should it be called? Send us your suggestions and we might feature the best one in a future edition. Global Pulse is a team effort. Thanks to editors Eli Reyes and Barbara Van Tine. Follow us on Twitter: @_daniel_payne and @carmenpaun. IN THE SPOTLIGHT The WHO will still have to convince individual governments to coordinate efforts and share resources, should they declare a public health emergency of international concern. | AP WHAT HAPPENS IF MONKEYPOX IS DECLARED GLOBAL HEALTH EMERGENCY? — Not much, unless countries decide to do more about the outbreak than they are now. The WHO will meet next Thursday to decide whether to declare a public health emergency of international concern over the increased spread of monkeypox, WHO Director General Tedros Adhanom Ghebreyesus said Tuesday. If the WHO decides to declare the emergency for monkeypox? "That doesn't really mean that much in concrete terms," Eric Toner, senior scholar at Johns Hopkins University, told Global Pulse. "I wouldn't expect it's going to make a huge difference." The WHO doesn't have much power to dictate the response to health crises — countries remain sovereign in their decisions. Still, declaring an emergency can urge countries to act faster and work with other governments to get the disease under control. "It's really a way for WHO to signal to public health agencies around the world that they take this quite seriously and this is an extraordinary event," Toner said — adding he isn't sure if monkeypox meets the designation. But not everyone agrees. The declarations still matter, and monkeypox meets the standards for one, said Lawrence Gostin, a public health law professor at Georgetown University. "Tedros was right to convene an emergency committee under the International Health Regulations," he wrote in an email to Global Pulse, adding that monkeypox meets the criteria for a global health emergency. "It is far better to take monkeypox seriously as a global health threat rather than to wait and see," Gostin said. "A 'wait and see' approach could let the virus spiral out of control." U.S. ASKED TO SHARE VACCINE SUPPLY — Advocacy groups — most recently Public Citizen, in a letter to the White House — asked the Biden administration to share some of its smallpox vaccine reserves to handle monkeypox outbreaks. The letter notes that the U.S. made a commitment in 2004 to provide millions of vaccine doses to the WHO in a smallpox emergency. Now, the WHO is asking countries to report their vaccine reserves and share doses for monkeypox outbreaks. The U.S. has yet to commit to the old agreement. Earlier this month, an HHS official told POLITICO a decision had not been made on whether the commitment would be upheld in this circumstance. "The Administration is actively discussing this with the World Health Organization and exploring all options to further expand our efforts to combat monkeypox domestically and globally," a senior administration official said in a statement to Global Pulse. "The United States has returned over 200,000 doses of the JYNNEOS vaccine to its manufacturer, Bavarian Nordic, to make them available to other countries."   INTRODUCING DIGITAL FUTURE DAILY - OUR TECHNOLOGY NEWSLETTER, RE-IMAGINED:  Technology is always evolving, and our new tech-obsessed newsletter is too! Digital Future Daily unlocks the most important stories determining the future of technology, from Washington to Silicon Valley and innovation power centers around the world. Readers get an in-depth look at how the next wave of tech will reshape civic and political life, including activism, fundraising, lobbying and legislating. Go inside the minds of the biggest tech players, policymakers and regulators to learn how their decisions affect our lives. Don't miss out, subscribe today.     DATA DIVE MONEY MATTERS PANDEMIC-PREPAREDNESS FEEDING FRENZY — This month is crucial for the pandemic preparedness fund created at the World Bank. With almost $1 billion in financial commitments mainly from the U.S. and the European Union, the so-called Financial Intermediary Fund is expected to be established later this month. The World Bank asked for input on the FIF's funding priorities, governance and operation — and the criticism didn't take long to arrive. Friends of the Global Fight complained that the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the vaccine alliance, are not currently eligible for funds. The two contribute to pandemic preparedness and "have demonstrated effectiveness during Covid-19," the group, which lobbies U.S. lawmakers on behalf of the Global Fund, wrote inits input. Who would get the money: The World Bank plans to direct the funds through the World Health Organization, other United Nations agencies and multilateral development banks. But the Independent Panel for Pandemic Preparedness and Response said showing results should be the main criteria to select entities for funding, not precedent. The panel, Australia and others list the Global Fund, Gavi, the Coalition for Epidemic Preparedness Innovations and the Africa CDC as worthy of funding. The panel questions the suitability of multilateral development banks to get money. The World Bank plan for the fund "is far too deferential to the established global financing approaches that have failed time and again to produce adequate pandemic preparedness and response," the panelwrote in its input.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     GLOBAL PULSE NUMBER 20 PERCENT The percentage drop in blood donations in Latin America and the Caribbean during the first year of the pandemic, compared to 2017, according to the Pan American Health Organization. WHAT WE'RE CLICKING Global Press Journal: First milk bank in Uganda fights misconceptions and infant mortality. The Washington Post: Covid is making flu and other common viruses act in unfamiliar ways. Reuters: Sri Lanka gives public workers one extra day off a week to grow food in response to shortage.   Follow us

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