Editorial: New challenge on horizon

With the World Health Organization (WHO) declaring monkeypox as a global health emergency, the healthcare administration must gear up to meet the new challenge without spreading panic. India has learnt some hard lessons from the devastating Covid-19 pandemic, scaled up its healthcare infrastructure and response systems and, therefore, is now in a better position to put in place the preventive and treatment strategies for monkeypox, a viral disease transmitted through close contact. Four cases have been reported in India so far while nearly 18,000 cases have been detected worldwide. Fortunately, monkeypox is less transmissible, and the infectious stage starts only after symptoms appear. This makes it possible for them to be identified and quarantined. Though a mild disease for a majority of the population, global data shows that children, pregnant women and immunosuppressed individuals are the most vulnerable groups, given the possibility of adverse outcomes in this population. While stepping up preventive measures, India must not lose time in starting negotiations for getting a manufacturing licence for the Jynneos vaccine for monkeypox. A vaccine production scale-up by India will help many other countries too. The United States has ordered nearly 7 million doses of the Jynneos vaccine for delivery in 2022 and 2023. But, many States in America are already reporting Jynneos shortages. This serves as a warning for India. The ongoing Monkeypox outbreak also raises questions about broader global public health response and collaboration. Despite the existence of the disease in 11 countries in Africa for more than five decades, the disease is getting global attention now only when high and upper-middle-income countries have been affected.

This reflects the inherent bias in global public health, where diseases of low and middle-income countries do not get commensurate priority for research and policy interventions. There is a need for technical discussion among experts, at all levels, regarding the possible use of smallpox vaccines for monkeypox outbreak situations. The National Technical Advisory Group on Immunization in India and the immunization working groups and expert committees of the professional associations should discuss possible target groups as well as come up with technical guidance on possible target groups, and plan, procure, stockpile and if needed, also plan for deployment of such vaccines. Monkeypox may have to be monitored for months, given the global surge. But this is a battle India can win, given its vast experience in the area of vaccination. In India, many viral and zoonotic diseases have emerged and re-emerged in the last two decades. With climate change, there are estimates of increased risks of cross-species viral transmission and zoonotic diseases. The interventions to tackle those diseases must focus on stronger primary healthcare and disease surveillance systems, trained public health workforce and a ‘One-health’ approach, where interventions are coordinated to protect the health of humans, animals and the ecosystem.